Health Care Fraud (HCF) Analyst

Overview
Join our dynamic team as a Health Care Fraud (HCF) Analyst and become a vital force in safeguarding the integrity of healthcare programs. In this role, you review documents, review and assess data, interview witnesses, coordinate with outside investigative entities and consult with Assistant U.S. Attorneys on investigation and prosecution strategy. Under the direction of an attorney, you will assist in obtaining documents and other information related to cases. You will research to locate potential witnesses; interview witnesses; conduct in-house, telephone and database research; and manage case files. You will report to attorneys on progress and assist in the preparation of reports and in case development, presentation and resolution.

Duties

• Develop an understanding of applicable federal, state and local statutes, regulations, and guidance to the extent necessary to make sound decisions on the direction and scope of investigations.
• Analyze publicly available materials, governmental databases and other such sources to identify possible violations of federal law. Conduct preliminary investigations to confirm such violations.
• Assist in the investigation of affirmative cases being handled by Assistant United States Attorneys, including the following: 1) Identifying witnesses. 2) Helping to create and implement an investigative plan, to develop strategy, and to provide direction to investigators from client agencies. 3) Drafting and monitoring subpoenas and other document requests and demands. 4) Reviewing and analyzing documents 5)Conducting interviews. 6) Producing well written interview reports, spreadsheets, status reports, recommendations, assessments and other analyses. 7) Utilizing forensic services to obtain and analyze evidence. 8) Coordinating and participating in surveillance. 9) Securing, organizing and preserving evidence 10) Building and presenting proof necessary for successful affirmative cases.
• Obtain and analyze financial records and information regarding assets and ability to pay of subjects under investigation utilizing electronic databases, publicly available sources, interviews and other investigative tools.
• Identify and develop human sources that may provide information regarding violations of federal law and assist in the investigations of such violations.
• Build and maintain excellent relationships with state, local, and federal law enforcement agencies in Michigan and neighboring jurisdictions involved in the investigation of violations of federal laws or fraud on federal programs, including participation in task forces.
• Other related duties as assigned and within scope. .

Skills and Qualifications

• 4-year undergraduate degree or higher in Criminal Justice or another relevant field is preferred but not required.
• Minimum 10 years of professional work experience in law enforcement including experience planning, conducting, and participating in complex investigations with at least seven years in a specialized expertise such as forfeiture, health care fraud, or other federal or state program frauds.
• Experience testifying in judicial or administrative proceedings.
• Working knowledge of current investigative techniques including conducting interviews and using commercial databases such as Lexis-Nexis, Westlaw, CLEAR, Accruing, Sentry, etc.; social media platforms, and other sources of information to obtain public records and financial records.
• U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.
• Experience and expertise in performing the requisite services .
• Relevant experience working with a federal or state legal or law enforcement entity assisting in fraud or federal or state investigations and trials, including familiarity with relevant statutes, elements of the violation(s) under investigation, rules of evidence, and constitutional rights of individuals.
• Working knowledge of health care fraud enforcement, including the relationships between federal and state law enforcement, administrative partners, and contractors.
• Proficient in the use of electronic document review platforms such as Relativity, Eclipse, or other similar platforms as well as the Microsoft Office suite (Microsoft Word, Excel, and PowerPoint, e.g.).
• Experience demonstrating the following capabilities: 1) Make contacts, maintain effective work relationships, and gain the confidence of others, including investigators from a variety of law enforcement agencies. 2) Develop source information, prepare for and conduct thorough witness interviews, and prepare reliable, well-written documentation of interviews. 3) Plan and conduct complex investigations in an expeditious manner with a minimal amount of direction/control. 4) Obtain information and develop evidence by observation, interviews, and examining and analyzing records. 5) Independently develop investigations by, among other things, recommending additional records and investigative steps. 6) Review, understand and analyze financial, billing, and other reporting information and materials. 7) Communicate both orally and in writing in a clear, concise, and logical manner, including preparing graphical representations of findings and conclusions for use as exhibits and testifying in court. 8) Analyze and objectively evaluate relevant facts and documentary evidence to arrive at sound conclusions. 9) Develop, obtain, analyze, organize, and preserve relevant evidence for trial purposes.

Pay: $40.00 - $48.00 per hour

Benefits:

• Health insurance
• Paid time off

Work Location: In person