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CGS Federal (Contact Government Services)

Federal professional services

Healthcare Fraud Investigator

Full-Time
$85k - $105k/yr
Mid
Bachelor's
Nashville, TN, USA+2 moreMore locations: Charlotte, NC, USA | Atlanta, GA, USA
HybridHybrid work is listed for Atlanta and as a work mode in the ATS locations.
Risk & ComplianceFinancial Crime & AML
No H1B Sponsorship
US Citizenship Required

About the job

Requirements
  • A four-year undergraduate degree or higher in criminal justice, finance, project management, or another related field.
  • At least three years of professional work experience in healthcare, fraud, or another related investigative field.
  • Proficiency in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.
  • Proficiency in analyzing data that supports specific case work in civil healthcare fraud matters, such as Medicare, Medicaid, and outlier data.
  • Ability to interact professionally and effectively with staff including Assistant United States Attorneys, support staff, client agencies, debtors and their attorneys and staff, court personnel, business executives, witnesses, and the public, using tact and diplomacy.
  • U.S. citizenship and ability to obtain adjudication for the requisite background investigation.
  • Experience and expertise performing the requisite services described in Section 3.
  • Ability to obtain a favorably adjudicated Public Trust clearance.
Responsibilities
  • Review, sort, and analyze data using computer software such as Microsoft Excel.
  • Review financial records and complex legal and regulatory documents, summarize their contents, conduct research as needed, and prepare spreadsheets of financial transactions such as check spreads.
  • Develop healthcare fraud case referrals and ensure they meet agency and United States Attorney's Office standards for litigation.
  • Analyze data for evidence of fraud, waste, and abuse.
  • Review and evaluate referrals to determine whether additional information and evidence are needed, and plan a comprehensive approach to obtain them.
  • Advise healthcare fraud attorneys on the merits and weaknesses of referrals based on applicable law, evidence of liability and damages, and potential defenses, and recommend whether to commence judicial proceedings.
  • Assist the United States Attorney's Office in developing referrals by maintaining working relationships with client agencies and the public, assisting with healthcare fraud training for federal, state, and local agencies, and preparing informational literature.
  • Assist with conducting witness interviews and preparing written summaries.
Desired Qualifications
  • Relevant healthcare fraud experience, including compliance, auditing, and other duties described in Section 3.
  • Relevant experience working with a federal or state legal or law enforcement entity.

About the company

C

CGS Federal (Contact Government Services)

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CGS Federal (Contact Government Services) is a government contractor providing professional and technology services to public agencies. The company supports federal programs with information technology, litigation support, records work, data services, cybersecurity, and program operations. It serves federal agencies, legal teams, public-sector program leaders, and mission-oriented operating units. Its operating model centers on contract teams embedded in regulated government environments and supported by recruiting, security, delivery, and corporate operations. Teams work across software, infrastructure, cybersecurity, legal support, data, project management, recruiting, and administration. Teams support coordinated daily delivery.

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