Sr. Investigator (Full-time, Remote)

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients with compliance and program integrity efforts. We focus on preventing and detecting fraud, waste, and abuse in government programs through data analytics, technology solutions, audit, investigation, and medical review. Our culture emphasizes opportunity, recognition, collaboration, and community support, offering a flexible workplace with an exceptional quality of life and a dynamic, idea-driven environment.

About the role

The Senior Investigator will conduct investigations supporting healthcare program integrity initiatives by identifying potential fraud, waste, and abuse (FWA). This role involves analyzing complex information, developing investigative findings, and recommending appropriate administrative or enforcement actions. The Senior Investigator will work 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.
• Investigate potential fraud, waste, and abuse in healthcare programs.
• 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.

Requirements

• 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 anomalies.
• Strong written, verbal, and interpersonal communication skills.
• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred (or may be required based on contract requirements).
• Ability to maintain confidentiality and exercise sound judgment.
• Ability to work independently and collaboratively within a team environment.
• Strong organizational skills with the ability to prioritize multiple assignments and meet deadlines.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Passion for supporting healthcare program integrity and IntegrityM's mission, vision, and values.

Benefits

• Vacation, sick leave, and paid holidays
• Health, dental, and 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: $55,000–$85,000. For candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity.