Fraud Investigator

Conduct field-based investigations related to Medicaid fraud, abuse, or non-compliance, aligned with UPIC protocols and state-specific Medicaid rules. Interview healthcare providers, beneficiaries, and witnesses to gather key case evidence. Analyze Medicaid claims, billing patterns, and supporting documentation to identify irregularities or suspicious activity. Prepare detailed investigative reports suitable for law enforcement referrals, overpayment recovery, or administrative actions. Collaborate with law enforcement entities, state Medicaid agencies, and CMS stakeholders. Maintain and manage documentation and case files in compliance with CMS and contractual standards. Represent Purisolve with professionalism and discretion during field engagements and stakeholder communications. Requirements 3+ years of investigative experience focused on Medicaid, Medicare, or healthcare program integrity. Demonstrated proficiency in interviewing, evidence gathering, and report drafting. Ability to work in a high-paced environment handling numerous concurrent investigations. Strong working knowledge of Medicaid policies, fraud typologies, and regulatory enforcement. Excellent written communication and attention to detail. Proficiency in Microsoft Office applications (Word, Excel, Outlook). Residence in Northeastern US and willingness to travel occasionally for site visits. Core Competencies Demonstrates expertise in conducting investigations related to Medicaid fraud and compliance, with strong skills in interviewing, evidence gathering, and report preparation. Proficient in analyzing Medicaid claims and collaborating with law enforcement and regulatory agencies. Highest-signal resume keywords Medicaid Fraud Investigation Interviewing Skills Report Drafting Medicaid Policy Knowledge Microsoft Office Proficiency Hard Skills Investigative Experience Evidence Gathering Report Preparation Claims Analysis Billing Pattern Analysis Soft Skills Attention to Detail Professionalism Discretion Communication Skills Industry Keywords Medicaid Medicare Healthcare Program Integrity Fraud Typologies Regulatory Enforcement Tools & Technologies Microsoft Word Microsoft Excel Microsoft Outlook #J-18808-Ljbffr