Marketplace Investigator

Marketplace Investigator – Centers for Medicare & Medicaid Services (CMS) Contribute to the protection of consumers, public funds, and the integrity of the ACA Marketplace through investigation, analysis, and report writing. Responsibilities Review documents and data from agents, brokers, and consumers related to marketplace enrollment and conduct detailed analysis. Identify and assess potential fraud, waste, or abuse (FWA) using enrollment and activity data. Prepare comprehensive investigative reports and case summaries for CMS. Develop and implement Investigative Plans of Action (IPOA) when appropriate and coordinate with investigative staff. Document all investigative activities within a case management system. Engage in outreach and interview consumers, agents/brokers, and partners, including law‑enforcement agencies. Provide administrative recommendations to CMS based on findings. Participate in educational and outreach sessions with stakeholders. Maintain confidentiality and follow SOPs for handling PII and PHI. Qualifications Bachelor’s degree in healthcare or related field, or equivalent experience. Minimum 3 years of related experience with ACA or Medicare/MediCare regulations. 2–4 years of ACA and/or Medicaid‑Medicare experience. Strong analytical, problem‑solving, and decision‑making skills. Experience reviewing complex data reports and conducting telephonic or in‑person interviews. Excellent written and oral communication and interpersonal skills. Proficient in Microsoft Office (Word, Excel). Requires only limited oversight to conduct work. Benefits Employer‑matched 401(k) plan. Comprehensive health, dental, vision, and wellness packages. Paid vacation, holidays, and paid time off. Professional growth opportunities including paid education and certifications. Flex‑work options where possible. Other Requirements Background check and U.S. residency for 3 of the last 5 years. May require infrequent travel. EEO Statement Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans #J-18808-Ljbffr