Senior Healthcare Fraud Investigator

Job not on LinkedIn

🔥 1 hour ago

🏛️ District of Columbia, Washington – Remote

🏛️ District of Columbia – Remote ☕ Washington – Remote

⏰ Full Time

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Arlo Solutions

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🎖️ Defense

🔒 Cybersecurity

Consulting • Defense • Cybersecurity

Arlo Solutions is a dynamic company dedicated to enhancing digital security and government technology since 2014. The company is composed of skilled data protectors, cybersecurity experts, and technology innovators focused on streamlining complex processes for government leaders. Arlo Solutions excels in providing seamless, cost-effective cybersecurity, program management, and intelligence solutions, ensuring a secure digital landscape. Recognized for their executive leadership and industry expertise, Arlo has gained both local and national recognition. The team is committed to using their insight and resources to meet client needs, primarily serving government sectors.

📋 Description

• Review and validate anomalies and prioritized leads from War Room analytics, including Provider 360, anomaly detection, and network analysis • Develop cases for potential community care provider fraud, waste and abuse and coordinated billing schemes • Build War Room referral packages supporting potential administrative actions, including provider removals, referral holds, recoupments, and oversight referrals • Help produce weekly analytic runs and decision-ready case packages containing facts, analysis, recommendations, and traceability • Prepare claim review workpapers and determination packages; apply case-file QA checklists and sampling plans • Help design the end-to-end case workflow from intake to closure, including roles, handoffs, SLAs, and escalation paths aligned with CIRTS triage practices • Contribute to intake and triage SOPs, case lifecycle and status taxonomy, and standard investigation templates • Maintain overpayment, recovery, referral status, oversight, and tracking registers • Provide investigative subject-matter input on fraud, waste and abuse typologies, rule logic, provider risk-scoring, and case-prioritization criteria • Perform case documentation and evidence work only under active federal investigator direction; do not open cases, make findings, or make referral decisions • Collaborate with OIC staff, VA OIG, and VHA stakeholders • Support ad hoc white papers, outcome summaries, and leadership briefings • Assist with training materials, kaizen sessions, after-action debriefs, and knowledge transfer so VA staff can operate the War Room independently by contract end

🎯 Requirements

• Bachelor's degree in a relevant field • 8+ years of federal healthcare program integrity and fraud investigations experience, such as Medicare/Medicaid and VHA healthcare fraud referrals and case development • Working knowledge of the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, and HHS OIG exclusion authorities • Strong written and verbal communication for executive-level audiences • Able to pass or hold a Tier 2 / Moderate Background Investigation (MBI) • Certified Fraud Examiner (CFE) certification desired • Current or prior VA/VHA system access, or current active VA contractor status desired • Experience working with HHS OIG, VA OIG, or other federal law enforcement on healthcare fraud referrals desired • Experience with VA Community Care claims, CMS program integrity data, or provider exclusion screening desired • Familiarity with Palantir or similar analytics and case-management platforms desired • Experience with CIRTS or similar compliance case-tracking systems desired • Knowledge of GAO Green Book, OMB A-123, and Payment Integrity Act fraud risk frameworks desired

🏖️ Benefits

• Affirmative Action and Equal Opportunity Employer • Work on a high-visibility Veterans Health Administration Fraud Rapid Response Center supporting VA operations • Knowledge transfer and training opportunities through training materials, kaizen sessions, after-action debriefs, and knowledge transfer