Remote opportunity at
Integrity Management Services, Inc.Investigator (Full-time, Remote)
IntegrityM, a women-owned small business, works with public and private clients on compliance and program integrity. Its services include analytics, technology, audits, investigations and medical reviews,…
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About This Role
IntegrityM, a women-owned small business, works with public and private clients on compliance and program integrity. Its services include analytics, technology, audits, investigations and medical reviews, aimed at spotting and deterring fraud, waste and abuse. This full-time, remote Investigator role conducts intricate Medicare and Medicaid probes and builds cases for later action. Those actions may include referral to law enforcement, referral to education efforts, overpayment recovery and other administrative measures.…
Job Description
IntegrityM, a women-owned small business, works with public and private clients on compliance and program integrity. Its services include analytics, technology, audits, investigations and medical reviews, aimed at spotting and deterring fraud, waste and abuse.
This full-time, remote Investigator role conducts intricate Medicare and Medicaid probes and builds cases for later action. Those actions may include referral to law enforcement, referral to education efforts, overpayment recovery and other administrative measures. The investigator works with internal staff and external agencies, both independently and as part of a team.
Core tasks include probing suspected health care fraud, waste and abuse, weighing findings to decide whether allegations are substantiated, maintaining detailed case files and tracking tools, researching claims data and policy requirements, and drafting reports that tie federal or state rules to each affected program. The role also works on joint cases with police, attorneys and CMS, reviews administrative action requests before they go to CMS, runs data analysis to detect patterns, and responds to data requests. Some field visits and face-to-face interviews may be part of the work.
Responsibilities
- Probe suspected health care fraud, waste and abuse by reviewing records, conducting interviews and gathering evidence
- Decide whether allegations are substantiated and choose corrective actions or referrals
- Keep case files complete and current, logging changes in the database and tracking system
- Dig through Medicare and Medicaid claims records and other sources to pin down policy requirements
- Draft investigative reports that tie federal or state rules to each affected program
- Partner on joint cases with police, attorneys, CMS and investigators at the state or federal level
- Review and approve administrative action requests before submission to CMS, and train and mentor colleagues
- Analyze claims data for fraud patterns and support new detection methods
Requirements
- Bachelor's degree in business or a related field with 5 to 7 years of experience in areas such as law enforcement investigation, statistics or data analysis
- Six-plus years investigating within health care
- At least three years of benefit integrity investigation or a closely related field
- Knowledge of Chapter 3 of the CMS Medicare Program Integrity Manual
- Familiarity with CPT and HCPCS Level II coding, plus ICD-10-CM and ICD-9-CM
- Experience reviewing claims for billing and coding compliance, medical review or fraud case development
- Strong investigative and advanced data analysis skills
- Passing a background check after hire and having reliable home internet are both needed for remote work
Qualifications
- CFE or AHFI certification (preferred)
- Grasp of Medicaid and contractor rules that govern coverage calls
Core Skills
Benefits
- Vacation and sick leave
- Paid holidays
- Medical, dental and eye coverage
- Income protection through short- and long-term disability plans and life cover
- Employee assistance plan
- Retirement savings through a 401(k)
- Educational benefits
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this role remote?
Yes. The posting lists the job as remote and requires reliable wired or wireless internet access.
What is the salary range?
The posting gives a U.S. remote annual range of $50,000 to $70,000. It says final pay depends on location, skills, experience and contract requirements.
Is a certification required?
No. A CFE or AHFI credential is listed as preferred rather than required.
Is travel required?
Some field work, such as visits and face-to-face interviews, may come up, but the posting gives no set travel schedule.
Sample Interview Questions
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