Senior Investigator

Integrity Management Services, Inc.

Senior Investigator conducting investigations for healthcare program integrity initiatives, analyzing potential fraud and collaborating with various stakeholders.

Posted 7/9/2026full-timeRemote • Virginia • 🇺🇸 United StatesSenior💰 $55,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

Conduct background research to identify relevant information regarding individuals, organizations, or entities under review.
Conduct investigations involving potential fraud, waste, and abuse.
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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Investigative ResearchData AnalysisHealthcare Claims ReviewPattern RecognitionReport Writing

Soft Skills

Problem-SolvingInterpersonal CommunicationOrganizational SkillsConfidentialityTeam Collaboration

Certifications

Certified Fraud Examiner (CFE)Accredited Healthcare Fraud Investigator (AHFI)