Job Overview
Location
Remote USA
Job Type
Full-time
Category
Data Science
Date Posted
June 14, 2026
Full Job Description
đź“‹ Description
- • Lead complex investigations into healthcare fraud, waste, and abuse (FWA) across Medicare and Medicaid programs, managing the full lifecycle of high-stakes cases requiring advanced investigative expertise.
- • Utilize advanced data mining and analysis techniques to detect anomalies in claims, medical records, enrollment data, and other healthcare transactions, identifying patterns indicative of fraudulent activity.
- • Serve as a subject matter expert for the Special Investigations Unit (SIU), providing guidance and mentorship to other investigators to enhance team capabilities and investigative standards.
- • Contribute to the development and refinement of FWA detection policies, procedures, and the annual SIU risk assessment and work plan based on emerging trends and investigative findings.
- • Prepare comprehensive, accurate, and compliant investigative reports and summary documentation for internal review and external referral to federal and state agencies, including participation in OIG Healthcare Fraud Workgroups.
- • Collaborate closely with internal stakeholders such as the FWA Monthly Workgroup, Market/Network teams, and Credentialing Committee to share intelligence, coordinate responses, and facilitate fund recovery efforts.
- • Conduct provider education sessions directly informed by investigation outcomes and audit results to deter future fraudulent behavior and promote compliance.
- • Act as the primary point of contact for corporate and field inquiries regarding FWA, engaging with providers, business partners, regulatory agencies, and law enforcement as needed.
- • Assist in the design and delivery of training programs on FWA detection and investigation for both internal teams and external audiences.
- • Maintain strict adherence to compliance standards and ethical practices, ensuring all investigations are conducted with integrity, meticulous attention to detail, and regulatory alignment.
- • Manage a diverse and concurrent caseload of complex investigations in a fast-paced environment, demonstrating strong organizational skills and the ability to prioritize effectively.
- • Leverage AI tools and other cutting-edge investigative technologies to enhance detection accuracy, streamline workflows, and improve case outcomes.
🎯 Requirements
- • Bachelor’s Degree in Business, Criminal Justice, Healthcare, or related field, or equivalent relevant work experience
- • Minimum of 3 years of dedicated experience in health insurance fraud investigation
- • Proven experience with Medicare and/or Medicaid programs, including medical claim billing, reimbursement, audit, or provider contracting
- • Demonstrated experience with data analysis techniques and AI tools
- • Exceptional written and verbal communication skills for report writing, presentations, and stakeholder engagement
- • Strong commitment to integrity, compliance, and meticulous attention to detail in all investigative work
🏖️ Benefits
- • Employer-sponsored health, dental, and vision plans with low or no premium
- • Generous paid time off
- • $100 monthly mobile or internet stipend
- • Stock options for all employees
- • Bonus eligibility for all roles excluding Director and above
- • 401K program and parental leave program
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Devoted Health, Inc.
Devoted Health, Inc. operates as a Medicare Advantage health plan provider, offering comprehensive coverage, personalized care navigation, and integrated technology to seniors across the United States. The company combines clinical expertise, data analytics, and member support services to coordinate physician visits, prescription management, and preventive care, aiming to improve health outcomes and reduce unnecessary costs for its members.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Harris Computer Systems Corporation
4 months ago
Government Employees Health Association, Inc.
6 months ago
Voyage Privé UK Ltd.
5 months ago
Scale Army Careers
4 months ago