Fraud Investigator - Federal Healthcare

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

• 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 $76,600 to $127,600. 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.

Deloitte is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to participate in the recruiting process, please direct your inquiries to the Global Call Center (GCC) at USTalentCICInbox@deloitte.com.