Senior Investigator (Full-time, Remote)

About Us

http://www.integritym.com

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 perks…Small company feel!

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 a…