{"id":2177829,"url":"https://alion.io/job/integritym-investigator-full-time-remote","title":"Investigator (Full-time, Remote)","company":{"id":681143,"name":"Integritym","domain":"integritym.com","url":"https://alion.io/company/integritym","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workable","truth_index":null},"role":"Operations","role_family":"Operations","seniority":null,"employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Alexandria, United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":50000,"max":70000,"currency":"USD","period":"year","gross":null,"usd_annual":70000},"salary_estimate":null,"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-09T14:23:35Z","employer_posted_date":"2026-10-09","last_verified_at":"2026-10-20T21:27:00Z","board_verified":true,"closed_at":null,"days_open":11,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":11},"description":"About Us\nhttp://www.integritym.com\nIntegrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.\nAt IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!\nIn this role, the Investigator will perform high level complex Medicare and Medicaid investigations and develop cases for future action, including referral to law enforcement, education, overpayment recovery and other administrative actions. The Investigator will work with internal resources and external agencies to develop cases and administrative actions as well as respond to requests for data and support. The Investigator works independently as well as collaboratively with various team members and managers.\nJob Responsibilities:\nConduct thorough investigations into alleged healthcare fraud, waste, and abuse (FWA) by researching relevant offenses, reviewing records, performing interviews, and collecting evidence through observation and document examination.\nAnalyze investigative findings to determine whether allegations are substantiated; collaborate with colleagues, including data analysts and subject matter experts, to develop appropriate corrective actions or referrals.\nDevelop, document, and maintain comprehensive case files in accordance with investigative standards, including timely updates in databases and case tracking tools.\nConduct research on Medicare and Medicaid claims data and other sources of information to establish policy requirements.\nPrepare detailed investigative reports that apply federal or state laws, rules, or regulations to the affected programs, clearly documenting findings to support follow-up actions or enforcement referrals.\nCoordinate with internal teams and external agencies-including law enforcement, legal counsel, CMS, and state or federal investigators-on joint investigations, case development, and information-sharing efforts.\nConduct background research on suspect providers to identify adverse business relationships, sanctions, exclusions, or other disqualifying information.\nReview and interpret relevant healthcare policies, regulations, and instructions to support findings and recommendations in FWA cases.\nMaintain high standards in fraud case development, ensuring that evidence is properly collected, documented, and safeguarded in compliance with rules of evidence and investigative guidelines.\nPerform data analysis on claims data to identify patterns or anomalies indicative of FWA; contribute insights to the development of new fraud scheme detection methodologies.\nRespond to law enforcement and client requests for data, documentation, or investigative support within specified timeframes.\nReviews and approves all administrative action requests prior to submitting to CMS and provide training and mentoring.\nMaintains statistics on all submitted administrative actions and maintains template documents used to submit and process administrative actions.\nConduct on-site visits and in-person interviews when required as part of investigative activities.\nRequirements\nJob Qualifications:\nBachelor degree in business or related field with 5-7 years experience (e.g., law enforcement investigation, statistics, data analysis).\n6+ years investigative experience in the Healthcare industry. \nAt least 3 years of experience in benefit integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions.\nKnowledge of CMS Medicare Program Integrity Manual, Chapter 3 - Verifying Potential Errors and Taking Corrective Actions.\nStrong investigative skills.\nAdvanced data analysis skills.\nKnowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT codes. Utilizes Medicaid and Contractor guidelines for coverage determinations.\nExperience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.\nCertified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI). (Preferred)\nMust pass post hire background screening checks.\n For remote work, required to have wired and/or wireless internet access.\nAbility to obtain security clearance, if required by Client/Contract\nBenefits\nThis position is eligible for the benefits applicable to full-time regular employees, such as: vacation, sick leave, paid holidays, health insurance, dental insurance, vision insurance, short- and long-term disability, life insurance, employee assistance plan, 401(K) retirement plan, and educational benefits.\nU.S. remote annual salary range: $50,000-$70,000/annual\nFor candidates in jurisdictions requiring range disclosure, this is the good-faith range for this role; final pay may vary by work location and job-related factors such as skills, experience, location, and internal equity. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.\nIntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.","description_format":"text","description_chars":6102,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Dental insurance","Equity","Flexible schedule","Health insurance","Life insurance","Professional development","Retirement plans","Vision insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Digital Government","Management Consulting"],"lifecycle":[{"event":"open","at":"2026-10-09T14:23:35Z"}],"visa":[],"liveness":{"score":70,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.777,"p_room":0.9,"age_days":10,"expected_fill_days":27,"reasons":["conf:1","win:mid"],"computed_at":"2026-10-20T05:45:00Z"},"pay":{"stated_usd_annual":70000,"is_top_pay":false},"html_url":"https://alion.io/job/integritym-investigator-full-time-remote","json_url":"https://alion.io/job/integritym-investigator-full-time-remote.json","meta":{"generated_at":"2026-10-21T00:31:06Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":800,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-22T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":681143},"rest":"https://alion.io/mcp/rest/get_company?id=681143"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fintegritym-investigator-full-time-remote"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fintegritym-investigator-full-time-remote"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fintegritym-investigator-full-time-remote"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/integritym-investigator-full-time-remote\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fintegritym-investigator-full-time-remote"}]}