Health Care Fraud Investigator - Pensacola, United States - KMRG, LLC

Description

ROLE

We are seeking an experienced Health Care Fraud Investigator to support the U.S. Attorney's Office (USAO) Northern District of Florida (NDFL). Your scope of work focuses on criminal and civil investigations of healthcare matters.

This is a full-time opportunity in which we'll provide competitive pay, comprehensive benefits, and job stability and security.

Apply today

RESPONSIBILITIES

• Plan and conduct investigations of complex nature
• Perform quantitative, qualitative, or other analysis of relevant facts
• Prepare and present the results of analysis findings to support USAO's mission
• Develop an understanding of applicable federal, state, and local laws related to investigations
• Work with key stakeholders and agencies (i.e., HHS, FBI, DCIS, and DEA)
• Manage cases independently with thoroughness and adherence to investigative protocols
• Collaborate with team members to address cases involving sensitive matters or prominent entities
• Analyze relevant facts and preparing results to support the USAO's mission
• Research background information using various databases and sources
• Identify subjects to investigate., develop leads, conduct interviews, and collect/process evidence
• Use analytical skills to identify and obtain financial and health care provider data
• Assist with building financial investigations regarding the subjects and their conduct
• Prepare reports, charts, graphs, videotapes, exhibits, and other audio-visual materials for hearings and trials
• Collect and process evidence
• Analyze health care, business, and financial records
• Conduct interviews of witnesses
• Collaborate with AUSAs, Paralegal Specialists, and supervisory attorneys
• Determine applicable statutory and regulatory laws
• Identify possible violations and build proof for case resolution
• Use electronic databases to identify assets, documents, and other physical evidence
• Prepare interim and final reports on progress of investigations (i.e., findings, conclusions, assessments, witnesses, etc.)
• Arrange for secure storage, preservation, organization, and indexing of voluminous documentary evidence
• Assist in compiling and analyzing documents and physical evidence
• Perform other ancillary services as needed to support assigned cases
• Help develop efficient methods for conducting investigations and identifying needed resources
• Initiate contacts with federal, state, and local officials, organizations, and individuals related to investigations
• Gather facts, obtain statements and explanations, and learn sequences of events
• Advance investigative objectives through proactive engagement with relevant officials and organizations
• Examine records (i.e., books, ledgers, payroll, cost reports, billing statements, invoices, correspondence, computer data)
• Establish and verify relationships among facts and evidence

KNOWLEDGE & SKILLS

• Knowledge of legal and law enforcement terms and procedures
• Knowledge of current investigative techniques (i.e., commercial databases and other sources of info.)
• Proficient in word processing, spreadsheet software, and Microsoft Office programs
• Excellent written and oral communication skills
• Proficient using common software programs (i.e., Excel, etc.) to present data (preferred)
• Knowledge of medical billing procedures (preferred)

BACKGROUND

• 4 years exp. in planning and conducting civil/criminal investigations for misuse of public, private, or insurance funds
• Exp. in analyzing, organizing, and presenting large volumes of data
• Exp. in reviewing and understanding medical records
• Exp. in conducting interviews with potential witnesses (preferred)
• Detail-oriented and organized
• Analytical

EDUCATION

• Bachelor's degree preferred

LOCATION

• 21 East Garden Street Pensacola, FL 32502

TELEWORK

• N/A

CLEARANCE

• U.S. citizenship required as it supports the U.S. federal government
• Completed T4, High Risk Level 6 Background Investigation (favorable)
• Valid driver's license

CLIENT

• Department of Justice (DOJ)

TRAVEL

• Travel may be required

WORK HOURS

• 40 hours per week
• 8 hours a day

EMPLOYMENT CLASSIFICATION

• Employment Classification Eligibility — Exempt

RELOCATION

• Not eligible for relocation benefits

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KMRG, LLC is an Equal Opportunity/Affirmative Action (EEO/AA) employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, gender identity, sexual orientation, ancestry, national origin, age, marital or civil partnership status, mental disability, physical disability, medical condition, pregnancy, maternity status, political affiliation, military or veteran status, genetic information, traits historically associated with race, or any other basis prohibited by federal, state, and/or local law.

Other Considerations. Applicants will be subject to a background investigation. Individual's primary workstation is located in an office area. The noise level in this environment is low to moderate. Regularly required to sit for extended periods up to 100% of the time; frequently required to move about to access file cabinets and use office equipment such as PC, copier, fax, telephone, cell phone, etc. Occasionally required to reach overhead, bend, and lift objects of up to 10 lbs. Specific vision abilities required by this job include the use of computer monitor screens up to 100% of the time.