Marketplace Investigator

Accountabilities

• Conduct investigations, analyze information, and prepare recommendations related to healthcare marketplace compliance activities.
• Manage sensitive information while following established procedures.
• Conduct research, analysis, and outreach activities to support marketplace program integrity investigations.
• Review documents, records, and data related to insurance agent, broker, consumer enrollment, and compliance activities.
• Analyze enrollment data and identify potential fraud, waste, abuse, or regulatory compliance concerns.
• Review documentation submitted by agents and brokers in response to registration, suspension, or termination actions and develop recommendations based on findings.
• Apply applicable policies, regulations, and procedures when evaluating investigation results.
• Develop investigative plans, case summaries, and supporting documentation as needed.
• Maintain detailed records of investigative activities within case management systems.
• Conduct interviews with consumers, complainants, agents, brokers, and other stakeholders when required.
• Support reporting activities, workflow improvements, and operational recommendations.
• Collaborate with subject matter experts, analysts, and external partners to achieve investigation goals.
• Safeguard personally identifiable information (PII) and protected health information (PHI) throughout all activities.

Requirements

• Bachelor’s degree or equivalent experience in healthcare, public policy, business, or a related field.
• 2+ years of experience with ACA, Medicaid, Medicare, or healthcare compliance-related programs.
• Experience understanding healthcare policies, regulations, enrollment requirements, and compliance responsibilities.
• Experience reviewing complex reports, analyzing data, and drawing conclusions from available information.
• Knowledge or experience with fraud, waste, and abuse (FWA) investigations is preferred.
• Strong problem-solving skills with the ability to evaluate information and make sound recommendations.
• Excellent written and verbal communication skills, including experience conducting interviews or stakeholder outreach.
• Highly organized with the ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office applications, particularly Word and Excel.
• Able to work independently with limited supervision while collaborating effectively within a team environment.
• Able to successfully complete required background screening, including U.S. residency verification requirements.

Benefits

• Competitive salary range of approximately $69,700 to $94,300 USD, depending on experience, location, and other factors.
• Fully remote work opportunity within the United States.
• Comprehensive medical, dental, and vision insurance options.
• 401(k) plan with company matching contributions.
• Paid vacation, sick leave, personal time, and company holidays.
• Paid parental, military, bereavement, and jury duty leave.
• Short- and long-term disability benefits.
• Life, accident, and critical illness insurance options.
• Professional development opportunities, including paid education and certifications.
• Opportunity to contribute to meaningful healthcare oversight and integrity initiatives.