Healthcare Fraud Investigator

Employment Type: Full-Time, Mid-Level. Department: Litigation Support.

About the role

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The investigator will take initiative, ask questions to complete tasks, perform detailed work consistently and accurately under pressure, and be enthusiastic about learning and applying knowledge to deliver excellent litigation support. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting‑edge technology, and offers an environment where employees feel supported and can grow through various learning opportunities.

Responsibilities

• Review, sort, and analyze data using computer software programs such as Microsoft Excel.
• Review financial records, complex legal and regulatory documents, summarize contents, and conduct research as needed.
• Prepare spreadsheets of financial transactions (e.g., check spreads).
• Develop HCF case referrals and ensure they 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 a comprehensive approach to obtain them.
• Advise HCF attorney(s) regarding the merits and weaknesses of referrals based on applicable law, evidence of liability and damages, and potential defenses; recommend for or against commencement of judicial proceedings.
• Assist the USAO in developing new referrals by maintaining good working relationships with client agencies and the public, supporting HCF training for federal, state, and local agencies, and preparing informational literature.
• Assist in conducting witness interviews and preparing written summaries.

Qualifications

• Four‑year undergraduate degree or higher in criminal justice, finance, project management, or a related field.
• Minimum three years of professional experience in healthcare, fraud, or a related investigative field.
• Proficiency in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.
• Experience analyzing data to support civil HCF matters (e.g., Medicare, Medicaid, outlier data).
• Strong communication skills; ability to interact professionally with AUSAs, support staff, client agencies, debtors, attorneys, court personnel, executives, witnesses, and the public with tact and diplomacy.
• U.S. citizenship and ability to obtain adjudication for the requisite background investigation.
• Ability to obtain a favorably adjudicated Public Trust Clearance.

Preferred qualifications

• Relevant healthcare fraud experience, including compliance, auditing duties, and related responsibilities.
• Experience working with a federal or state legal or law‑enforcement entity.

Pay

$85,000 – $105,000 a year