Fraud Investigator

Summary

Employment Type: Full-Time, Mid-LevelDepartment: Litigation SupportCGS 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 ExcelReview 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 litigationAnalyze data for evidence of fraud, waste and abuseReview and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidenceAdvise 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 proceedingsAssist 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, etcAssist conducting witness interviews and preparing written summariesQualifications:Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related fieldMinimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of workProficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etcProficiency 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 diplomacyU.S. Citizenship and ability to obtain adjudication for the requisite background investigationExperience and expertise in performing the requisite services in Section 3Must be a US CitizenMust be able to obtain a favorably adjudicated Public Trust ClearancePreferred qualifications:Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3Relevant experience working with a federal or state legal or law enforcement entityWe may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. 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.#J-18808-Ljbffr

Job Description

Employment Type: Full-Time, Mid-LevelDepartment: Litigation SupportCGS 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 ExcelReview 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 litigationAnalyze data for evidence of fraud, waste and abuseReview and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidenceAdvise 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 proceedingsAssist 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, etcAssist conducting witness interviews and preparing written summariesQualifications:Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related fieldMinimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of workProficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etcProficiency 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 diplomacyU.S. Citizenship and ability to obtain adjudication for the requisite background investigationExperience and expertise in performing the requisite services in Section 3Must be a US CitizenMust be able to obtain a favorably adjudicated Public Trust ClearancePreferred qualifications:Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3Relevant experience working with a federal or state legal or law enforcement entityWe may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. 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.#J-18808-Ljbffr