Investigator

• conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse
• Investigate matters of program integrity to prevent payment of aberrant claims submitted to the Medicaid lines of business for payment
• Conduct thorough research on subject(s) and related entities
• Initiate independently proactive data mining using SIU Tools to identify aberrant billing patterns and early scheme detection
• Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme
• Research and prepare cases for both clinical and legal review
• Collaborate with Medical Directors on clinical issues and medical record questions
• Accurately documents all case activity and communications in designated case tracking system
• Communicate clinical findings to provider
• Adherent to all regulatory requirements
• Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing
• Provide training and guidance to new and junior investigators
• Assist junior Investigators in identifying resources for cases; offer suggestions on investigative strategy
• Serve as back up to the Team Leader as necessary
• Collaborate with federal, state, and local law enforcement agencies for the investigation and prosecution of healthcare fraud issues
• Experience in witness testimony; Proficient in testifying for both civil and criminal proceedings
• Communicate clearly a high level of FWA knowledge and understanding during interactions with both internal and external stakeholders
• Communicate ideas on efficiency gains; provides input regarding controls for monitoring FWA among the business segments

Senior Investigator in healthcare fraud and abuse for CVS Health

Senior Investigator, Special Investigations Unit

Senior Investigator in healthcare fraud and abuse for CVS Health. Conducting complex investigations and collaborating with law enforcement agencies on fraud issues.

• Conducting surveillance including covert, stationery, and mobile
• Conducting surveillance throughout their home state and surrounding states
• Recording subject activity on a video recording device
• Conducting alive and well checks, locates, basic scene investigations, paint sample analysis, EDR, and RCS deployments/retrievals
• Preparing and completing a written report of observations
• Uploading Video Evidence and a surveillance report

Full Time Private Investigator conducting surveillance for Advantage Investigations

Field Investigator

Full Time Private Investigator conducting surveillance for Advantage Investigations across MA. Responsibilities include covert surveillance and daily activity investigations.

• The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.
• Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations.
• Performs a variety of ancillary investigations-related services in direct support of any assigned fraud.
• Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence.
• Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys.

ACE Investigator with expertise in investigative techniques for Federal agency initiative

Civil Enforcement Investigator

ACE Investigator with extensive knowledge in investigative techniques and fraud detection for Federal agency initiative. Join CGS in government innovation through collaborative efforts.

Investigator jobs in Massachusetts

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Senior Investigator, Special Investigations Unit

Field Investigator

Civil Enforcement Investigator