Investigator (Full-time, Remote)

About the role

Integrity Management Services, Inc. is a women-owned small business specializing in fraud, waste, and abuse prevention and detection in government programs. The organization supports government and commercial clients through data analytics, technology solutions, audits, investigations, and medical reviews to enhance program integrity. The INVESTIGATOR role involves conducting complex Medicare and Medicaid investigations to identify fraud, waste, and abuse. This position plays a critical role in developing cases for administrative actions or law enforcement referral, collaborating with internal teams and external agencies to protect program integrity.

Responsibilities

• Conduct investigations into alleged healthcare fraud, waste, and abuse using research, interviews, and evidence collection.
• Analyze findings to substantiate allegations and recommend corrective actions or referrals.
• Develop and maintain detailed case files and investigative reports.
• Research Medicare and Medicaid claims data to support policy compliance.
• Coordinate with internal teams and external agencies on investigations and information sharing.
• Perform background research on providers for sanctions or exclusions.
• Review healthcare policies and regulations relevant to fraud cases.
• Ensure proper evidence collection and compliance with investigative guidelines.
• Analyze claims data to identify fraud patterns and support detection methodologies.
• Respond to data and support requests from law enforcement and clients.
• Review and approve administrative action requests before submission to CMS.
• Maintain statistics and templates related to administrative actions.
• Conduct on-site visits and interviews as necessary.

Requirements

• Bachelor’s degree in business or related field with 5-7 years of relevant experience.
• Minimum 6 years investigative experience in the healthcare industry.
• At least 3 years in benefit integrity investigation or related fields.
• Knowledge of CMS Medicare Program Integrity Manual, Chapter 3.
• Strong investigative and advanced data analysis skills.
• Familiarity with medical terminology, coding systems (ICD-9-CM, ICD-10-CM, HCPCS, CPT).
• Experience reviewing claims for billing and medical coding compliance.
• Certified Fraud Examiner or Accredited Health Care Fraud Investigator preferred.
• Ability to pass post-hire background screening.
• Wired or wireless internet access for remote work.
• Ability to obtain security clearance if required.

Benefits

• 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.
• Educational benefits.

Pay

U.S. remote annual salary range: $50,000-$70,000.