Senior Healthcare Fraud Investigator

Arlo Solutions

. Review and validate anomalies and prioritized leads from War Room analytics, including Provider 360, anomaly detection, and network analysis .

Posted 9/30/2026full-timeRemote • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in federal healthcare program integrity and fraud investigations, with a strong focus on case development and compliance. Proficient in analyzing fraud, waste, and abuse typologies while collaborating with federal law enforcement and stakeholders.

Highest-signal resume keywords

Federal Healthcare Program IntegrityFraud Investigations ExperienceKnowledge of False Claims ActCertified Fraud Examiner (CFE)Experience with HHS OIG

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case DevelopmentAnomaly DetectionProvider Risk-ScoringCase DocumentationClaim ReviewData AnalysisWorkflow DesignQuality AssuranceFraud Risk FrameworksCase Lifecycle Management

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationCollaborationTraining DevelopmentAnalytical Thinking

Tools & Technologies

PalantirCIRTSAnalytics PlatformsCase-Management Systems

Certifications & Qualifications

Certified Fraud Examiner (CFE)

Industry Keywords

MedicareMedicaidVHA HealthcareFalse Claims ActAnti-Kickback StatuteStark LawCivil Monetary Penalties LawHHS OIG Exclusion AuthoritiesGAO Green BookPayment Integrity Act

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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