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Posted: 9/23/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong analytical and investigative skills to evaluate referrals and complaints, conduct research, and report findings related to potential fraud within the Medicare program. Proficient in data analysis, documentation, and effective communication with various stakeholders.
Highest-signal resume keywords
Investigative ExperienceData AnalysisRegulatory InterpretationVerbal And Written CommunicationOrganizational Skills
About the role
Key responsibilities & impact- Use a variety of tools to evaluate referrals and complaints and develop investigations to identify potential fraud
- Respond to referrals from other entities
- Field requests for data and support
- Analyze and interpret claims data for aberrancies
- Conduct interviews
- Report findings and take quick, appropriate follow-up actions
- Refer cases to field investigative teams or the data team for further analysis
- Perform research and draw conclusions
- Present issues of concern, citing regulatory violations and alleging schemes or scams to defraud the Government
- Organize case files and accurately document all steps taken
- Conduct background investigations on providers within the Medicare program
- Compose correspondence, reports, and referral summary letters
- Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
Requirements
What you’ll need- 0 years with BS/BA; 4 years with a HS Degree
- Strong interpersonal, analytical, research, and organizational skills
- Excellent verbal and written communications
- Strong PC knowledge and skills
- Strong use of Excel and ability to sort and filter data
- Strong time management and organizational skills
- Self-driven and motivated
- U.S. citizenship required
- 1 or 2 years of investigative or analytical experience preferred
- May be required to appear in court to testify about work findings
- Ability to communicate effectively, internally, and externally
- Ability to interpret laws and regulations
- Ability to handle confidential material
- Ability to report work activity on a timely basis
- Ability to work independently and as a member of a team
- Ability to attend meetings, training, and conferences; some overnight travel required
Benefits
Comp & perks- Telework available from Florida
- Employees may be eligible for overtime
- Employees may be eligible for shift differential
- Employees may be eligible for a discretionary bonus
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisResearch SkillsExcel ProficiencyReport WritingBackground Investigations
Soft Skills
Interpersonal SkillsTime ManagementSelf-MotivationTeam CollaborationEffective Communication
Tools & Technologies
PC KnowledgeExcel
Industry Keywords
Medicare ProgramFraud InvestigationRegulatory ViolationsConfidential Material HandlingProvider Education