Senior Fraud and Waste Investigator, Medicaid

Location: Remote from Illinois. Work is scheduled Monday through Friday, 40 hours per week, between 7 AM and 5 PM EST depending on business needs. Occasional travel to hirify.global offices and less than 10% local or regional travel within Illinois may be required.

Salary: $71,100–$97,800 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and health insurance company serving Medicare, Medicaid, individual, family, and military healthcare markets.

What you will do

• Investigate allegations of fraud, waste, abuse, and other improper practices involving Medicaid.
• Coordinate investigations with law enforcement authorities and assemble evidence for adjudication.
• Conduct on-site audits of provider records and evaluate billing practices.
• Analyze claims and other data to identify patterns, metrics, and investigative findings.
• Prepare complex investigation and audit reports.
• Influence departmental strategy and determine technical approaches independently.

Requirements

• Must reside in Illinois.
• At least three years of fraud investigations and/or auditing experience.
• Ability to analyze data and work with investigative metrics.
• Proficiency with Microsoft Word, Excel, Access, Outlook, and related computer systems.
• Strong personal and professional ethics and an inquisitive approach.
• Work during 7 AM–5 PM EST business hours and occasional local or regional travel are required.

Nice to have

• Bachelor’s degree in business, finance, criminal justice, or a related field.
• Graduate degree or certifications such as MBA, J.D., MSN, CPC, CCS, CFE, or AHFI.
• Medicaid investigations experience and knowledge of healthcare claims processing.
• Experience developing investigative processes and understanding corporate business operations.

Culture & Benefits

• Remote work with a dedicated, interruption-free workspace required to protect member PHI and HIPAA information.
• Home internet service must provide at least 25 Mbps download and 10 Mbps upload; satellite and cellular connections are not permitted.
• hirify.global provides appropriate telephone equipment and reimburses internet expenses biweekly for eligible associates working from home in Illinois and certain other states.
• Benefits include medical, dental, and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.