Sr. Investigator (Full-time, Remote)

About Us

Integrity Management Services Inc. (IntegrityM) is an award-winning women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts including the prevention and detection of fraud waste and abuse in government programs. Results are achieved through data analytics technology solutions audit investigation and medical review.

At IntegrityM we offer a culture of opportunity recognition collaboration and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic idea-driven environment that nurtures our employees professional development. Large company perksSmall company feel!

Description

We are seeking a Senior Investigator to join our 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

• Bachelors 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 IntegrityMs mission vision and values.

This position is eligible for the benefits applicable to full-time regular employees such as: 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 and educational benefits.

U.S. remote annual salary range: $55000-$85000/annual

For candidates in jurisdictions requiring range disclosure this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills experience location and internal equity. This is not however a guarantee of compensation or salary. Rather salary will be set based on experience geographic location and possibly contractual requirements and could fall outside of this range.

IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race color sex age national origin religion sexual orientation and gender identity status as a veteran and basis of disability or any other federal state or local protected class.

Required Experience:

Senior IC