Senior Investigator (Healthcare Fraud) 7/26/2018

Verscend Waltham, MA

Waltham, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


As a Senior Investigator, you will investigate suspected incidents of fraud, waste or abuse. This position may be based either in our Towson, MD office or can be worked remotely from home anywhere in the US.


* Identify, investigate, analyze and evaluate instances of potential fraud, waste and abuse.

* Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review.

* Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.

* Conducts investigation-related training.

* Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.

* Negotiates settlement agreements to resolve disputes.

* Maintain current knowledge of relevant laws, regulations and standards.

* Participates in special projects as required.


* Bachelor's Degree in related discipline, or the equivalent combination of education, professional training and work experience.

* 5-8 years of related investigative experience.

* Excellent verbal and written communication skills.

* Strong listening and observation skills.

* Attention to detail and high level of accuracy.

* Effective organizational and prioritization skills with multi-tasking ability

* Preferred certifications:


* Accredited Healthcare Fraud Investigator (AHFI),

* Certified Fraud Specialist (CFS),

* Certified Fraud Examiner (CFE),

* Certified Professional Coder (CPC)

* Certified Forensic Interviewer (CFI), or

* Certified in Healthcare Compliance (CHC).

Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor s legal duty to furnish information.