Medicaid Investigator – Northeast

Purisolve, Inc.

Medicaid Investigator focusing on fraud and compliance investigations under NE UPIC contract. Responsible for field investigations and collaborate with law enforcement in the Northeastern US.

Posted 7/27/2026full-timeNew Jersey, New York, Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting investigations related to Medicaid fraud and compliance, with strong skills in interviewing, evidence gathering, and report preparation. Proficient in analyzing Medicaid claims and collaborating with law enforcement and regulatory agencies.

Highest-signal resume keywords

Medicaid Fraud InvestigationInterviewing SkillsReport DraftingMedicaid Policy KnowledgeMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ExperienceEvidence GatheringReport PreparationClaims AnalysisBilling Pattern Analysis

Soft Skills

Attention to DetailProfessionalismDiscretionCommunication Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Outlook

Industry Keywords

MedicaidMedicareHealthcare Program IntegrityFraud TypologiesRegulatory Enforcement

About the role

Key responsibilities & impact

Conduct field-based investigations related to Medicaid fraud, abuse, or non-compliance, aligned with UPIC protocols and state-specific Medicaid rules.
Interview healthcare providers, beneficiaries, and witnesses to gather key case evidence.
Analyze Medicaid claims, billing patterns, and supporting documentation to identify irregularities or suspicious activity.
Prepare detailed investigative reports suitable for law enforcement referrals, overpayment recovery, or administrative actions.
Collaborate with law enforcement entities, state Medicaid agencies, and CMS stakeholders.
Maintain and manage documentation and case files in compliance with CMS and contractual standards.
Represent Purisolve with professionalism and discretion during field engagements and stakeholder communications.

Requirements

What you’ll need

3+ years of investigative experience focused on Medicaid, Medicare, or healthcare program integrity.
Demonstrated proficiency in interviewing, evidence gathering, and report drafting.
Ability to work in a high-paced environment handling numerous concurrent investigations.
Strong working knowledge of Medicaid policies, fraud typologies, and regulatory enforcement.
Excellent written communication and attention to detail.
Proficiency in Microsoft Office applications (Word, Excel, Outlook).
Residence in Northeastern US and willingness to travel occasionally for site visits.

Benefits

Comp & perks

Health insurance
Professional development opportunities
Remote work options