Investigator II (Healthcare Fraud)

TL;DR

Investigator II (Healthcare Fraud): Leading end-to-end fraud investigations to safeguard healthcare integrity with an accent on evidence analysis, pattern identification, and case documentation. Focus on conducting interviews, supporting legal proceedings, and enhancing fraud prevention strategies through data-driven insights.

Location: Must be based in the USA, with occasional travel across Tennessee and periodic time in the Chattanooga office.

Company

hirify.global is a healthcare organization dedicated to serving its members and protecting the integrity of healthcare resources.

What you will do

• Lead end-to-end fraud investigations by analyzing evidence and identifying patterns.
• Conduct interviews with involved parties to determine the validity of claims.
• Prepare comprehensive legal and investigation documentation for management review.
• Present findings and recommendations to leadership to support decision-making.
• Participate in legal proceedings as required.
• Identify trends to strengthen internal controls and fraud prevention strategies.

Requirements

• Must be based in the USA as sponsorship is not available.
• Bachelor's degree or 4 years of equivalent professional corporate experience.
• 8 years of experience in healthcare fraud or white-collar criminal investigations.
• Proficiency in Microsoft Office suite.
• Excellent oral and written communication skills.
• Ability to work independently and handle multiple projects simultaneously.

Nice to have

• Certified Fraud Examiner (CFE) designation.
• Accredited Health Care Fraud Investigator (AHFI) certification.
• Associate, Life and Health Claims (ALHC) certification.
• Certified Insurance Fraud Investigator (CIFI) designation.

Culture & Benefits

• Collaborative team environment with direct impact on member services.
• Culture of innovation including the responsible use of AI-enabled tools.
• Opportunity to work on complex, high-stakes investigations.
• Professional development and support for industry certifications.