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Position Summary We are seeking a Senior Healthcare Fraud Investigator to support our program integrity efforts through hands-on investigation of potential fraud, waste, and abuse (FWA). This role is ideal for someone who thrives on digging into data, managing complex cases, and driving investigations from start to finish. You’ll play a key role in identifying risk, analyzing claims activity, and supporting compliance with state and federal healthcare regulations—particularly within Medicaid programs. Key Responsibilities • Independently manage a caseload of fraud, waste, and abuse investigations from identification through resolution, • Analyze healthcare claims data to detect unusual billing patterns, trends, and potential fraud indicators, • Conduct detailed research and develop cases using data, documentation, and interviews, • Interview providers, members, and other parties to gather actionable information, • Prepare clear, comprehensive investigative reports and documentation suitable for internal review and external agencies, • Partner with compliance, legal, and external stakeholders to support investigations and reporting requirements, • Respond to requests for information from regulatory agencies and support audit activities, • Identify opportunities for overpayment recovery, cost savings, and risk mitigation, • Stay current on emerging fraud schemes, regulatory changes, and industry trends This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: • Bachelor level education - Required, • Minimum 5-7 years' experience in a healthcare program integrity position ensuring compliance with regulatory and contractual requirements. - Required, • Ability to work independently with minimal supervision, and manage a high volume of assignments, • High degree of integrity and confidentiality required handling information that is considered personal and confidential, • Analytical skills and ability to make deductions; logical and sequential thinker, • Strong verbal and written communication skills., • Healthcare industry and/or Medicaid/CHIP knowledge required, healthcare claims knowledge and experience - Preferred., • Knowledge and experience working on various approaches to healthcare fraud, waste, and abuse, • Working knowledge of Microsoft applications, Excel - Required., • Knowledge of available resources (internal and external) to assist in investigations., • Medical terminology knowledge and/or experience with CPT and ICD-10 coding - Preferred., • Knowledge of suspected FWA trends, potential schemes, and matters of interest to law enforcement and regulators., • Accredited Health Care Fraud Investigator (AHFI) and/or Certified Fraud Examiner (CFE) - Preferred, • Community Care Plan offers support for obtaining certification for qualified candidates. SKILLS AND ABILITIES: • Ability to communicate effectively, verbal and written, • Ability to self-motivate, • Strong time management skills, • Ability to prioritize and organize FWA program activities, • Ability to meticulously document case actions and findings for regulatory reporting and any legal action, if applicable, • Ability to collaborate, • Results oriented skills PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Background Screening Notice: In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse. The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants. Additional information is available at: 🔗 hhttps://info.flclearinghouse.com

Job DescriptionHealthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Responsibilities will Include:- Review, sort, and analyze data using computer software programs such as Microsoft Excel.- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).- Develop HCF case referrals including, but not limited to:- Ensure that HCF referrals meet agency and USAO standards for litigation.- Analyze data for evidence of fraud, waste and abuse.- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc. - Assist conducting witness interviews and preparing written summaries. Qualifications:- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.- Experience and expertise in performing the requisite services in Section 3.- Must be a US Citizen.- Must be able to obtain a favorably adjudicated Public Trust Clearance.Preferred qualifications:- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.- Relevant experience working with a federal or state legal or law enforcement entity. #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Job DescriptionAffirmative Civil Enforcement (ACE) InvestigatorEmployment Type: Full-Time, Experienced Department: Legal Services CGS is seeking an experienced ACE Investigator with extensive knowledge and skills in investigative techniques and fraud detection to provide assistance for a large Federal agency initiative. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:- The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.- Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations.- Performs a variety of ancillary investigations-related services in direct support of any assigned fraud- Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence.- Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys. These reports may include significant findings and conclusions, analyses of information located in electronic databases, presentations, recommendations for additional investigative actions and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of a case.- Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.- Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue.- Gathers and analyzes facts including witness statements, timelines, and scientific or technical data for the purpose of advancing investigative objectives. Establishes and verifies relationships between facts and evidence obtained or presented to confirm authenticity of documents, to corroborate witness statements, and to otherwise build proof necessary for successful litigation or settlement.- Develops and analyzes evidence and collects information relating to such evidence, or other legal matters under consideration, from appropriate primary and secondary sources. Performs analysis to clarify the target suspect's or organization's pattern of operations, to identify information relevant to the legal issues involved, and to recommend valuable approaches to the AUSAs or other members of the investigative team. Develops and refines proof required to assist in determining legal responsibility for violations.- Assists ACE AUSAs with in-person and/or telephonic interviews of witnesses, depositions, and sworn witness examinations.- Assists with the preparation and service of subpoenas for documentary materials, interrogatory answers, or witness testimony in connection with ACE investigations.- Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to affix responsibility for violations, and devise methods for obtaining, preserving, and presenting evidence to the greatest effect.- Assists with determining the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.- Performs other related ACE investigator duties as assigned and within scope.- Attends meetings and trainings as may be required and appropriate. Qualifications:- Computer Skills: Applicant shall have the ability to use MS Word, MS Excel, MS Outlook, MS Access, and other databases as well as Adobe Acrobat Professional. Experience with working on document review/management platforms such as Relativity, with analyzing spreadsheets of claims data, and with utilizing docketing software is a plus.- Ability to review and understand the import of a wide variety of documents, both legal and non-legal, including Motions and Briefs.- Ability to think independently and to develop investigative strategies in response to the needs of a specific case.- Communication skills are extremely important. Applicant shall work and interact professionally and effectively with all levels of staff.- Ability to meet established deadlines and work as a team player in a professional office.- Skill in meeting and dealing with people in a courteous and tactful manner. Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board:https://cgsfederal.com/join-our-team/For more information about CGS please visit: https://www.cgsfederal.com or contact:Email: info@cgsfederal.com #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. Relevant healthcare fraud experience including compliance, auditing duties, and other duties in Section 3. Minimum three (3) years of professional work experience in healthcare, f

We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies.Earn up to $750 a week in your free time by providing feedback on everyday products and services.If you're comfortable sharing your opi

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Enter and retrieve information contained in computer databases using a keyboard, mouse, or trackball to update records, files, reservations, and answer inquiries from guests.Transmit information or documents using a computer, mail, or facsimile machine.Operate standard office equipment other than co

Were looking for a dependable and detail-oriented.Bilingual Administrative Assistant.This role is ideal for someone who is organized, compassionate, and able to communicate clearly with both English- and Spanish-speaking families and team members.If you have the required skills,.Mon-Fri 9am-5:30pm w

Full-Time Scheduler & Administrative Assistant.ComForCare Home Care is a privately owned home care agency.We take time to understand the needs of our clients and work diligently to keep them safe at home.With ComForCare, clients can live independently and continue to do the things they love.As a Ful

Enter and retrieve information contained in computer databases using a keyboard, mouse, or trackball to update records, files, reservations, and answer inquiries from guests.Transmit information or documents using a computer, mail, or facsimile machine.Operate standard office equipment other than co

ComForCare Home Care is a privately owned home care agency.We take time to understand the needs of our clients and work diligently to keep them safe at home.With ComForCare, clients can live independently and continue to do the things they love.As a Full-Time Scheduler & Administrative Assistant at

Assist in the daily operation of the management office and administrative duties following established Company procedures and guidelines.Perform administrative assistant functions including but not limited to: record keeping, filing, mail collection and distribution, word processing, data entry, mai

Doeren Mayhew is the 37th largest U.Troy, Michigan with over 25 offices across the country and abroad.Founded in 1932, Doeren Mayhew is positioned for successful future growth.If you want to join a rising firm that is consistently named among the 50 best-managed firms in the nation, this is the firm

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This position provides administrative and secretarial support for your home department.In addition to typing, filing and scheduling, performs duties such as financial record keeping, payroll, coordination of meetings and conferences, obtaining supplies, coordinating direct mailings, and working on s

Administrative Assistant - Nursing Associate Program.Provides comprehensive administrative support to the nursing program faculty, staff, and students while facilitating course delivery and program operations.Serves as the primary point of contact for nursing program inquiries and ensures smooth dai

Accounting Administrative Assistant.We are looking for a reliable and detail-oriented Accounting Administrative Assistant to support daily financial and office operations.This role involves maintaining accurate accounting records, assisting with payroll processing, and providing general administrati

Assists the Ridinger Family on various personal and professional duties administrative tasks.Essential Duties and Responsibilities.Prepares and organizes meetings, parties, and other social events with the events department.Serves as admin in business ventures, managing a heavy calendar, scheduling

Oak View Group is the global leader in venue development, management, and premium hospitality services for the live event industry.Offering an unmatched, 360-degree solution set for a collection of world-class owned venues and a client roster that includes the most influential, highest attended aren

IF YOU CREATE THE STAGE SETTING AND IT IS GRAND, EVERYONE WHO ENTERS WILL PLAY THEIR PART.Morris Lapidus A spectacular blend of Golden Era glamour and modern luxury, Fontainebleau today reinvents the original vision of legendary architect Morris Lapidus - a stage where everyone plays their unique pa

Executive Administrative Assistant.Nation Security is searching for a highly skilled and organized Executive Administrative Assistant to support our executive team.The ideal candidate will possess a strong background in executive support, exceptional communication skills, and the ability to manage m

UMHC - SCCC - Aventura has an exciting opportunity for a Sr.Administrative Assistant (H) position.The incumbent performs a variety of clerical functions and office support activities for the assigned department(s) to facilitate the efficient operations of the office.Supports department and/or depart

Our purpose is to provide help and inspire confidence in our clients and communities everywhere.Our associates feel a sense of belonging in an inclusive place with an amazing history and a sharp focus on our future.Our connected culture is who we are and how we work together to achieve our strategie

The Administrative Assistant serves as faculty support for Law School Professors, Adjunct Professors, Visiting Professors, reporting to the Office Manager and the Law School HR Director.Employees in this position should be detail oriented, have excellent communication and organizational skills, and

Award-Winning Wellness Program and Healthcare Premium Incentives.

Administrative Support Position.Position at Seaboard Marine Starting rate: $19 per hour Long-term employment with opportunities for growth.We offer excellent benefits including:.K) Retirement Saving Plan w/ Employer Match.Low-Cost Health, Dental & Vision insurance (Starting DAY ONE).Tuition & Certif

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Phoenix Pro Connect is supporting the search for a detail-oriented and organized Administrative Assistant to join a dynamic private equity office based in Miami.This role plays a vital part in maintaining smooth and efficient office operations, with a strong focus on document management, mail handli

West Kendall Toyota - Miami, FL 33186.We presently have an employment opportunity for an Administrative Assistant in our operations.In this new role, the primary responsibilities of the Administrative Assistant is to assist the dealer in routine clerical and administrative duties.Excellent verbal an

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Hotel Administrative Assistant.This team is responsible for providing consistent personalized service to our guests with the ultimate goal of achieving total guest satisfaction.To be a successful member of this team, a candidate should have a passion for service, a pleasant and energetic demeanor, a

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All compensation and pay rates are dependent upon skills and experience.PrideStaff is an equal opportunity employer.