Healthcare Fraud Investigator

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Council Capital

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2000

🏥 Healthcare

💸 Finance

Healthcare • Finance

Council Capital is a healthcare-focused private investment firm that partners with growth-stage, EBITDA-positive healthcare technology and healthcare services companies. They provide capital plus strategic, operational and network support through an experienced investment team, a Value Creation team, and a CEO Council of industry leaders (the CEO Council has personally invested more than $140M in the funds). Council Capital targets mission-driven, often founder-led or bootstrapped businesses with enterprise values typically up to $100M and emphasizes hands-on partnership to accelerate performance and growth.

📋 Description

• Identify and qualify 100%+ of budgeted leads each month (roughly 15), taking each from concept to an accepted lead. • Earn at least 50% lead acceptance/concept approval from clients. • Carry an active caseload of 20 to 30 cases per month, owning each case from open to close. • Close 90% of individual cases within four to five months. • Convert case value into recovered dollars, hitting at least 100% of your top-line revenue target (roughly 45% of identified value converting to gross revenue). • Maintain a 95% first-time acceptance rate on documentation sent to customers. • Keep payer complaints at zero and minimize provider abrasion across every interaction. • Work fluently across Medicare, Medicaid, Commercial, and FEP lines of business.

🎯 Requirements

• 2+ years at a healthcare payer or vendor as an Investigator or Auditor working with healthcare claims. • Experience across multiple lines of business (Medicare, Medicaid, Commercial, FEP). • Proficiency with auditing software, case management systems, and claims systems. • Experience owning the full investigation workflow, from lead to revenue. • Sound analytical judgment and the ability to negotiate favorable, defensible outcomes. • U.S.-based with work authorization (no offshore; PHI environment).

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements • Professional development