Senior Investigator

Role Description

We are seeking a Senior Investigator to join our team. In this role, the Senior Investigator will conduct investigations that support healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA), analyzing complex information, and developing investigative findings. The Senior Investigator will use a variety of investigative techniques and analytical tools to identify subjects, develop cases, document findings, and recommend appropriate administrative or enforcement actions. This position works both independently and collaboratively with investigators, analysts, subject matter experts, and program leadership.

Responsibilities

• Conduct background research to identify relevant information regarding individuals, organizations, or entities under review.
• Conduct investigations involving potential fraud, waste, and abuse.
• Analyze healthcare and operational data to identify trends, anomalies, and potential indicators of fraud.
• Review applicable laws, regulations, policies, and guidance to support investigative activities.
• Collect, review, and analyze records and documentation relevant to investigations.
• Conduct interviews and maintain accountability for evidentiary materials in accordance with established procedures.
• Document investigative findings and prepare clear, well-supported reports and recommendations.
• Coordinate with internal staff, legal counsel, government stakeholders, and law enforcement agencies, as appropriate.
• Collaborate with investigators, analysts, program managers, and subject matter experts to develop investigative strategies and resolve cases.
• Enter and maintain investigative information in case management and tracking systems.
• Present investigative findings and recommendations to management and clients.
• Assist with identifying emerging fraud schemes and recommending new investigative priorities.
• Prepare recurring and ad hoc reports regarding investigative activities and case status.
• Meet established quality standards and project deadlines.

Qualifications

• Bachelor's degree in criminal justice, law enforcement, healthcare administration, data analysis, or a related field, or equivalent combination of education and relevant experience.
• Two or more years of experience supporting healthcare program integrity, fraud investigations, Medicare, Medicaid, commercial healthcare, or other government healthcare programs.
• Experience conducting fraud, waste, and abuse investigations preferred.
• Strong investigative, analytical, and problem-solving skills.
• Experience reviewing healthcare claims, enrollment records, medical records, or other complex documentation.
• Experience analyzing complex data and identifying patterns or anomalies.
• Strong written, verbal, and interpersonal communication skills.
• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred (or may be required based on contract requirements).
• Ability to maintain confidentiality and exercise sound judgment.
• Ability to work independently and collaboratively within a team environment.
• Strong organizational skills with the ability to prioritize multiple assignments and meet deadlines.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Passion for supporting healthcare program integrity and IntegrityM's mission, vision, and values.

Benefits

• Vacation
• Sick leave
• Paid holidays
• Health insurance
• Dental insurance
• Vision insurance
• Short- and long-term disability
• Life insurance
• Employee assistance plan
• 401(K) retirement plan
• Educational benefits