Fraud Auditor

About the role

CGS seeks a Fraud Analyst to provide financial, forensic, and investigative support to government attorneys in the investigation and litigation of complex civil and criminal fraud matters. The Fraud Analyst will analyze financial and medical claims data, conduct forensic audits, develop damages assessments, and prepare reports and evidence to support investigations, prosecutions, settlements, and recoveries.

Responsibilities

• Assists the client in the investigation and trial preparation phases by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex
• Maintains confidentiality of individually identifiable medical information, matters under seal such as qui tam lawsuits, matters occurring before the grand jury, and sensitive matters involving prominent individuals, organizations, or corporations within a client's district
• Performs comprehensive analytical, investigative, and financial examination duties in support of the client
• Conducts audits in support of investigations and litigation involving the government's affirmative civil enforcement of federal laws, particularly the False Claims Act, 31 U.S.C 3729-3733, the Anti-Kickback Statute, 42 U.S.C 1320a-7b(b)(1)(A), and the Stark Law, 42 U.S.C 1395nn(a)
• Conducts similar audits in support of criminal investigations involving 18 U.S. Code 641, 18 U.S.C. 1343—Elements of Wire Fraud, 18 U.S.C 1341, 18 U.S.C 1347, 18 USC 1956: Laundering of monetary instruments, 18 U.S.C 1957
• Reviews, analyzes, and interprets complex data sets, including Centers for Medicare & Medicaid Services claims data, PPP loan data, and records associated with health care fraud, defense procurement fraud, and other government program fraud
• Identifies outlier billings and other anomalies within health care claim codes and normalizes claims data across multiple benefit plans to support time studies and other analytical assessments
• Detects trends, patterns, and relevant information within investigative and discovery records and applies this analysis to test data under various conditions
• Reinterprets and extrapolates results from Statistically Valid Random Samples when modifications to sample review outcomes occur
• Develops, documents, and defends loss calculation methodologies and financial damage models for litigation
• Conducts financial investigations to assess the ability of individuals and organizations to satisfy settlements and judgments, including detailed analysis of assets, liabilities, debt covenants, borrowing capacity, earnings, financial ratios, aging schedules, tax considerations, and collectability
• Examines personal and business financial records to identify payments, kickbacks, money flows, sources and uses of cash, related-party transactions, and potential damages
• Performs asset valuations, records reconstruction, and creation of computerized financial models for use in presentations of financial evidence
• Prepares clear, accurate reports summarizing financial analyses, data findings, and evidentiary conclusions
• Communicates investigative findings to attorneys, investigators, and other team members, and provides recommendations to client regarding investigative plans, areas of focus, and potential courses of action
• Reviews defense presentations, expert reports, and related materials, and collaborates with independent experts as needed
• Prepares expert reports for litigation and participates in negotiations upon request
• Professionally engages with witnesses, persons of interest, and representatives of local, state, and federal agencies to obtain statements, clarify facts, and establish sequences of events in support of investigative objectives
• Participates in the Suspicious Activity Report (SAR) Review Team, reviewing FINCEN reports to generate investigative leads for law enforcement and assisting in de-conflicting pending investigations

Qualifications

• Must be Certified Public Accountant
• MBA or equivalent in accounting or directly related field
• Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards
• Minimum of three years' experience as an auditor
• Minimum two years specialized experience in the specific subject matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems
• Working knowledge of appropriate accounting and financial analysis ADP systems and applications
• Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards
• Working knowledge of appropriate accounting and financial analysis ADP systems and applications
• Excellent oral and written communication skills
• Experience in litigation environment, experience working with automated litigation support helpful

Benefits

• Health, Dental, and Vision
• Life Insurance
• 401k
• Flexible Spending Account (Health, Dependent Care, and Commuter)
• Paid Time Off and Observance of State/Federal Holidays

This response is AI-generated, for reference only.