Full-time Remote Investigator

Job Description A bit about this role: Are you a highly analytical and

experienced investigator with a passion for uncovering the truth and protecting

vital healthcare resources? Our Special Investigations Unit (SIU) is looking for

a skilled Investigator to join our dedicated team. In this crucial role, you'll

be at the forefront of preventing, detecting, and responding to healthcare

fraud, waste, and abuse (FWA), safeguarding our members and the integrity of the

Medicare Fund. If you're driven by meticulous investigation, data-driven

insights, and a commitment to justice, we encourage you to apply.

Responsibilities and Impact will include: As an SIU Investigator, you'll be

responsible for the full lifecycle of complex FWA investigations, acting as a

subject matter expert and collaborating with various stakeholders. Your key

responsibilities will include: Lead Complex Investigations: Plan, organize, and

execute specialized investigations into allegations of healthcare fraud, waste,

and abuse. This includes handling intricate cases requiring advanced

investigative knowledge and skills. Data-Driven Detection: Utilize advanced data

mining and analysis techniques to identify aberrancies and outliers in claims,

medical records, enrollment, and other healthcare transactions. You'll

independently research FWA issues and employ cutting-edge investigative

resources. Expert Guidance: Serve as a subject matter expert for other SIU

Investigators, providing specialized knowledge and guidance to elevate team

capabilities. Policy & Strategy Development: Contribute to the development of

robust policies and procedures related to FWA detection and investigation, as

well as the annual SIU risk assessment and work plan. Thorough Documentation &

Reporting: Conduct comprehensive FWA investigations, ensuring complete and

accurate case documentation and detailed investigative reports that adhere to

SIU policies and standards. External Referrals & Collaboration: Prepare

comprehensive summary and detailed reports on investigative findings for

referral to federal and state agencies, ensuring full compliance with regulatory

requirements. You'll also actively participate in OIG Healthcare Fraud

Workgroups. Stakeholder Engagement: Collaborate closely with internal

stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing

Committee) to share updates on FWA schemes, coordinate recommendations, and

facilitate fund recovery or other necessary actions. Provider Education: Conduct

impactful provider education sessions as a direct response to investigation

findings and audits. Liaison & Point of Contact: Serve as a key point of contact

for corporate and field inquiries regarding FWA, and participate in meetings

with providers, business partners, regulatory agencies, and law enforcement.

Training & Development: Assist in developing and presenting engaging FWA

training programs for internal and external audiences. Required skills and

experience: Education: A Bachelor’s Degree in Business, Criminal Justice,

Healthcare, or a related field, or equivalent relevant work experience.

Experience:Minimum of 3 years of dedicated experience in health insurance fraud

investigation. Proven experience within Medicare and/or Medicaid programs,

specifically with medical claim billing, reimbursement, audit, or provider

contracting. Demonstrated experience with data analysis techniques. Experience

with the Healthcare Fraud Shield platform is a significant plus. Exceptional

Analytical Skills: Ability to interpret and dissect complex data sets,

identifying patterns and anomalies indicative of FWA. Must have demonstrated

experience with AI tools. Outstanding Communication: Excellent written and

verbal communication skills are essential for clear report writing, compelling

presentations, and effective stakeholder engagement. Integrity &

Detail-Oriented: A strong commitment to integrity and compliance, coupled with

meticulous attention to detail in all aspects of investigations. Independent &

Collaborative: Proven ability to work independently, manage a diverse caseload

of investigations, and thrive in a fast-paced environment, while also excelling

in collaborative team settings. Strong Organizational Skills: Highly organized

with the ability to manage multiple complex investigations simultaneously and

effectively prioritize tasks. Desired skills and experience: Certified Fraud

Examiner (CFE) Certified Professional Coder (CPC) #LI-DS1 #LI-Remote Salary

range: $58,000 - $90,000 /year The pay range listed for this position is the

range the organization reasonably and in good faith expects to pay for this

position at the time of the posting. Once the interview process begins, your

talent partner will provide additional information on the compensation for the

role, along with additional information on our total rewards package. The actual

base salary offered will depend on a variety of factors, including the

qualifications of the individual applicant for the position, years of relevant

experience, specific and unique skills, level of education attained,

certifications or other professional licenses held, and the location in which

the applicant lives and/or from which they will be performing the job. Our Total

Rewards package includes: Employer sponsored health, dental and vision plan with

low or no premium Generous paid time off $100 monthly mobile or internet stipend

Stock options for all employees Bonus eligibility for all roles excluding

Director and above; Commission eligibility for Sales roles Parental leave

program 401K program And more.... *Our total rewards package is for full time

employees only. Intern and Contract positions are not eligible. Healthcare

equality is at the center of Devoted’s mission to treat our members like family.

We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on

a mission to dramatically improve the health and well-being of older Americans

by caring for every person like family. That’s why we’re gathering smart,

diverse, and big-hearted people to create a new kind of all-in-one healthcare

company — one that combines compassion, health insurance, clinical care,

service, and technology - to deliver a complete and integrated healthcare

solution that delivers high quality care that everyone would want for someone

they love. Founded in 2017, we've grown fast and now serve members across the

United States. And we've just started. So join us on this mission! Devoted is an

equal opportunity employer. We are committed to a safe and supportive work

environment in which all employees have the opportunity to participate and

contribute to the success of the business. We value diversity and collaboration.

Individuals are respected for their skills, experience, and unique perspectives.

This commitment is embodied in Devoted’s Code of Conduct, our company values and

the way we do business. As an Equal Opportunity Employer, the Company does not

discriminate on the basis of race, color, religion, sex, pregnancy status,

marital status, national origin, disability, age, sexual orientation, veteran

status, genetic information, gender identity, gender expression, or any other

factor prohibited by law. Our management team is dedicated to this policy with

respect to recruitment, hiring, placement, promotion, transfer, training,

compensation, benefits, employee activities and general treatment during

employment. We have been made aware of instances of fraudulent job postings

and/or fraudulent recruiting activity by individuals purporting to represent

Devoted Health. These fraudulent schemes often seek monetary contributions or

payments from job seekers (such as for “start up costs” or “equipment”), or seek

to collect sensitive personal information. These job postings and offers are NOT

authorized by Devoted Health and Devoted is not responsible for fraudulent

offers, personal information that you may have disclosed, or payments made to

third parties purporting to represent Devoted. We have reported this matter and

are cooperating with law enforcement agencies. Devoted Health will never ask for

financial commitment or contribution from a candidate at any stage of the

recruitment process.