Senior Investigator - Lead Validation (Healthcare FWA) [Remote]

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Investigator – Lead Validation (Healthcare FWA) based in the United States.

This role is centered on protecting the integrity of the healthcare system by identifying, investigating, and analyzing potential fraud, waste, and abuse through advanced data-driven methods. You will operate within a post-pay investigative environment, leveraging claims data, analytics tools, and trend identification techniques to detect suspicious provider behavior and billing anomalies. The position is highly analytical, requiring strong expertise in data mining, pattern recognition, and structured investigative reasoning. You will translate complex findings into clear, actionable reports and recommendations that support compliance, recovery, and enforcement actions. A key aspect of the role involves collaborating with internal teams and external stakeholders, including legal and law enforcement partners when necessary. This is a fully remote, detail-intensive role for a professional who thrives in investigative analysis and data interpretation within a regulated healthcare setting. Your work will directly contribute to reducing financial loss and improving the integrity of healthcare claims systems.

Accountabilities:

• Identify, investigate, and evaluate potential cases of healthcare fraud, waste, and abuse using claims data, analytics tools, and investigative methodologies.
• Monitor provider behavior to detect anomalies, trends, and patterns that may indicate non-compliant or suspicious activity.
• Conduct advanced data analysis using Excel and other tools to support detection, validation, and escalation of potential FWA cases.
• Develop detailed investigative summaries and presentations outlining findings, conclusions, and recommended actions.
• Utilize sampling, data extrapolation techniques, and investigative frameworks to support case development and validation efforts.
• Collaborate with internal stakeholders and external partners, including legal teams and law enforcement, to support case resolution and proceedings when required.
• Deliver training and knowledge-sharing sessions related to investigative processes, fraud detection techniques, and compliance standards.
• Maintain up-to-date knowledge of healthcare regulations, coding guidelines, and fraud prevention best practices.

Requirements:

• Bachelor’s degree in a related field or equivalent combination of education and relevant professional experience.
• 5–8 years of experience in healthcare fraud, waste, and abuse investigations or related analytical/compliance roles.
• Advanced proficiency in Excel, including data analysis, pattern detection, and reporting.
• Strong experience in proactive data mining and investigative analysis within large datasets.
• Familiarity with sampling and extrapolation techniques (RAT-STATS experience preferred).
• Experience working with FWA or claims investigation tools (e.g., Sentinel, Commander, Informant or similar platforms) is a plus.
• Strong analytical thinking skills with exceptional attention to detail and accuracy.
• Excellent written and verbal communication skills, with the ability to present complex findings clearly.
• Strong organizational and multitasking abilities in a remote, deadline-driven environment.
• Preferred certifications such as AHFI, CFE, CFS, CHC, or CFI are a plus.

Benefits:

• Competitive base salary ranging from $70,000 – $90,000 USD , depending on experience and qualifications
• Comprehensive benefits package including medical, dental, vision, disability, and life insurance
• 401(k) retirement savings plan with employer participation
• Paid time off ranging from 17–27 days depending on level and tenure
• Nine paid company holidays annually
• Paid family leave and additional employee support programs
• Flexible remote work environment with provided equipment
• Professional development opportunities in healthcare analytics and fraud investigation
• Eligibility for additional compensation based on role level and organizational needs.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.