Fraud and Waste Investigator (Healthcare)

TL;DR

Fraud and Waste Investigator (Healthcare): Investigating allegations of fraudulent and abusive healthcare practices with an accent on evidence gathering, payment methodologies, and complex investigative reporting. Focus on coordinating with compliance, business partners, and law enforcement, analyzing claims data, and supporting successful adjudication.

Location: Remote anywhere in the United States; occasional travel to hirify.global offices for training or meetings may be required. Work hours are Monday through Friday, 40 hours per week, with an expectation to work during EST business hours and start between 6:00 AM and 9:00 AM in the employee's time zone. Up to 5% travel may be required.

Salary: $65,000–$88,600 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a large U.S. healthcare and health insurance company serving Medicare, Medicaid, families, individuals, military personnel, and communities.

What you will do

• Conduct investigations into allegations of healthcare fraud and abusive practices.
• Coordinate investigations with compliance, internal business partners, external entities, and law enforcement.
• Collect evidence and prepare documentation to support adjudication.
• Prepare complex investigative and audit reports.
• Analyze data and apply healthcare payment methodologies to identify relevant findings.
• Work independently within established procedures and provide guidance when needed.

Requirements

• Bachelor's degree.
• At least 2 years of experience in healthcare fraud investigations.
• Knowledge of healthcare payment methodologies.
• Strong organizational, interpersonal, communication, analytical, and ethical judgment skills.
• Computer literacy, including Microsoft Word, Excel, and Access.
• Ability to work remotely from the United States and meet EST-oriented working hours.

Nice to have

• Experience with Medicare fraud investigations.
• Spanish bilingual proficiency.
• MBA, J.D., MSN, clinical certifications, CPC, CCS, CFE, or AHFI credentials.
• Knowledge of healthcare claims processing, investigative process development, and business operations.

Culture & Benefits

• Remote work from home with occasional office travel for training or meetings.
• Professional development and continuing education opportunities.
• Medical, dental, and vision insurance.
• 401(k), paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and wellness-focused benefits.
• A dedicated, interruption-free workspace and reliable internet connection are required to protect member PHI and HIPAA information.

Hiring process

• Application prescreen followed by a prerecorded voice interview and/or SMS text interview through HireVue.
• Initial interviews take approximately 5–15 minutes, followed by additional interview rounds for selected candidates.