Healthcare Fraud Investigator

Job Description

Job Description

Healthcare Fraud Investigator

Employment Type: Full-Time, Mid-Level

Department: Litigation Support

CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 

CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.

Responsibilities will Include:

- Review, sort, and analyze data using computer software programs such as Microsoft Excel.

- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).

- Develop HCF case referrals including, but not limited to:

- Ensure that HCF referrals meet agency and USAO standards for litigation.

- Analyze data for evidence of fraud, waste and abuse.

- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.

- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.

- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.

- Assist conducting witness interviews and preparing written summaries.

Qualifications:

- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.

- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.

- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.

- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).

- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.

- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.

- Experience and expertise in performing the requisite services in Section 3.

- Must be a US Citizen.

- Must be able to obtain a favorably adjudicated Public Trust Clearance.

Preferred qualifications:

- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.

- Relevant experience working with a federal or state legal or law enforcement entity.

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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.