Investigator, Special Investigations Unit (SIU)

Employment Type: Full time

Position Overview

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. We are a fast-growing, all-in-one healthcare company combining compassion, health insurance, clinical care, service, and technology to deliver a complete and integrated healthcare solution.

Our Special Investigations Unit (SIU) is seeking a highly analytical and experienced Investigator to join our dedicated team. In this crucial role, you will be at the forefront of preventing, detecting, and responding to healthcare fraud, waste, and abuse (FWA), safeguarding our members and the integrity of the Medicare Fund. If you are driven by meticulous investigation, data-driven insights, and a commitment to justice, we encourage you to apply.

Responsibilities and Impact

As an SIU Investigator, you will be responsible for the full lifecycle of complex FWA investigations, acting as a subject matter expert and collaborating with various stakeholders. Your key responsibilities will include:

• Lead Complex Investigations: Plan, organize, and execute specialized investigations into allegations of healthcare fraud, waste, and abuse. This includes handling intricate cases requiring advanced investigative knowledge and skills.
• Data-Driven Detection: Utilize advanced data mining and analysis techniques to identify aberrancies and outliers in claims, medical records, enrollment, and other healthcare transactions. You will independently research FWA issues and employ cutting-edge investigative resources.
• Expert Guidance: Serve as a subject matter expert for other SIU Investigators, providing specialized knowledge and guidance to elevate team capabilities.
• Policy & Strategy Development: Contribute to the development of robust policies and procedures related to FWA detection and investigation, as well as the annual SIU risk assessment and work plan.
• Thorough Documentation & Reporting: Conduct comprehensive FWA investigations, ensuring complete and accurate case documentation and detailed investigative reports that adhere to SIU policies and standards.
• External Referrals & Collaboration: Prepare comprehensive summary and detailed reports on investigative findings for referral to federal and state agencies, ensuring full compliance with regulatory requirements. You will also actively participate in OIG Healthcare Fraud Workgroups.
• Stakeholder Engagement: Collaborate closely with internal stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing Committee) to share updates on FWA schemes, coordinate recommendations, and facilitate fund recovery or other necessary actions.
• Provider Education: Conduct impactful provider education sessions as a direct response to investigation findings and audits.
• Liaison & Point of Contact: Serve as a key point of contact for corporate and field inquiries regarding FWA, and participate in meetings with providers, business partners, regulatory agencies, and law enforcement.
• Training & Development: Assist in developing and presenting engaging FWA training programs for internal and external audiences.

Required Skills and Experience

• Education: A Bachelor’s Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent relevant work experience.
• Experience:
  • Minimum of 3 years of dedicated experience in health insurance fraud investigation.
  • Proven experience within Medicare and/or Medicaid programs, specifically related to FWA investigations.

Company Information

Founded in 2017, Devoted Health has grown rapidly and now serves members across the United States. We are committed to creating a new kind of all-in-one healthcare company that delivers high-quality care that everyone would want for someone they love. Join us on our mission!