Full-Time
Healthcare Fraud Investigator
CGS Federal (Contact Government Services)
Compensation Overview
$85k - $105k/yr
No H1B Sponsorship
Nashville, TN, USA + 1 more
More locations: Atlanta, GA, USA
Hybrid
Hybrid role; in-office days required in Atlanta, GA and Nashville, TN as needed.
US Top Secret Clearance Required
Category
 Legal & Compliance (1) |
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Required Skills
Word/Pages/Docs
Data Analysis
Excel/Numbers/Sheets
PowerPoint/Keynote/Slides
Requirements
- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.
- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.
- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.
- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil Healthcare Fraud matters (e.g., Medicare data, Medicaid data, outlier data).
- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.
- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.
- Must be a US Citizen.
- Must be able to obtain a favorably adjudicated Public Trust Clearance.
- Experience and expertise in performing the requisite services in Section 3.
Responsibilities
- Review, sort, and analyze data using computer software programs such as Microsoft Excel.
- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).
- Develop HCF case referrals including, but not limited to:
- Ensure that HCF referrals meet agency and USAO standards for litigation.
- Analyze data for evidence of fraud, waste and abuse.
- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.
- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.
- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.
- Assist conducting witness interviews and preparing written summaries.
Desired Qualifications
- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.
- Relevant experience working with a federal or state legal or law enforcement entity.