Fraud Investigator - Federal Healthcare
Deloitte US · Rosslyn, United States · 24d ago
Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.
Work You’ll Do
As a Project - Consultant, Forensics and Investigations on the project, you will address the threats that perpetuate fraud, waste, and abuse, our clients look to our team to provide the guidance and solutions required to help them stay ahead of emerging issues and protect the integrity of their programs. Responsibilities will include:
- Work with a team of investigators responsible for developing investigations and referrals of suspected healthcare fraud for potential action.
- Utilize specialized databases, customized applications, development, and configuration management.
- Collaborate with government program representatives, law enforcement, and case teams to gather, design, and implement sound investigative and referral procedures that meet quality and evidentiary standards as required.
- Contribute to vulnerability detection, investigative workflow, quality review, and presentation of findings.
- Support AI-enabled workflows and coordinate with analytics teams for structured and unstructured data.
- Analyze health insurance claims data, open source, and public information to identify new and emerging fraud schemes and identify suspicious billing patterns or other activities indicative of potentially fraudulent behavior.
- Conduct analysis of open source and public information to identify sources of identity theft.
- Develop fraud referrals for presentation to the client, law enforcement, and other government agencies.
- Identify public health insurance program vulnerabilities through data analytics and open-source information.
The successful candidate would possess these skills:
- Ability to work independently and collaborate as part of a team
- Effective written and verbal communication skills
- Meticulous attention to detail and quality of work product
- Ability to build and sustain professional relationships
- Ability to lead projects or workstreams
- Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
- Strong interpersonal skills and professional demeanor
- Ability to meet deadlines
- Ability to provide clear guidance to others
The Team
Deloitte’s Government & Public Services (GPS) practice – our people, ideas, technology and outcomes – is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.
Our Enterprise Operations & Risk offering enables clients to achieve profitable growth and competitive advantage by optimizing “heart of the business” operations. Leverages deep domain expertise to extend enterprise resilience, agility and remediation. Addresses client needs which span the organization and impact strategy, operations, performance and reputation.
The Project Talent Model is designed for professionals with specialized skills that align to a current client need. Team members focus on delivering services to clients, without additional expectations related to business development or promotion. Their employment is tied to their role on a project, and they are eligible for a benefits package that is competitive for project-focused professionals.
Qualifications
Required:
- Bachelor’s degree required
- 2+ years of experience with claims analysis
- Experience with fraud detection
- Must be a Certified Fraud Examiner (CFE)
- Must be able to obtain and maintain the required clearance for this role
- Ability to travel 25%, on average, based on the work you do and the clients and industries/sectors you serve
- Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
Preferred:
- Strong grasp of healthcare claims
- Experience with electronic health records, and Microsoft Excel.
For individuals assigned and/or hired to work in Arlington, Virginia, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to Arlington, Virginia and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At Deloitte, it is not typical for an individual to be hired at or
near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $97,700to $162,800.
You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.