Sr. Healthcare Fraud Investigator

1st Choice is seeking an experienced Senior Healthcare Fraud Investigator to support federal healthcare fraud investigations. This role will assist government attorneys and investigative teams in identifying, analyzing, and developing complex healthcare fraud cases involving Medicare, Medicaid, and other federal healthcare programs.

The investigator will conduct financial and billing analysis, review medical and claims data, support case development, and prepare investigative reports used in civil and criminal healthcare fraud prosecutions.

This position requires strong analytical skills, familiarity with healthcare billing practices, and the ability to work within a federal investigative and litigation support environment.

• Location: Birmingham, Alabama
• Schedule: Approximately 30 hours per week

• Key ResponsibilitiesHealthcare Fraud Investigations: Conduct analysis of healthcare billing records and claims data to identify potential fraud schemes involving Medicare, Medicaid, and other healthcare programs.
• Data and Financial Analysis: Review financial records, medical billing documentation, and provider claims to detect anomalies, irregular billing patterns, and potential fraudulent activity.
• Case Development Support: Assist investigative teams and attorneys with developing healthcare fraud cases by organizing records, summarizing findings, and preparing case documentation.
• Investigative Reporting: Prepare written reports, summaries, and analytical findings that support ongoing investigations and potential legal proceedings.
• Document Review and Evidence Analysis: Review large volumes of medical and financial documentation to identify evidence relevant to fraud investigations.
• Collaboration with Investigative Teams: Work with attorneys, investigators, and other enforcement partners to support the development of complex healthcare fraud cases.
• Litigation Preparation: Assist with case preparation activities including compiling exhibits, preparing summaries of evidence, and supporting investigative briefings.

• Required QualificationsBachelor’s degree in accounting, finance, healthcare administration, criminal justice, or a related field
• ORMinimum five years of experience conducting healthcare fraud investigations, audits, or financial analysis related to healthcare programs
• Experience analyzing healthcare billing data, claims records, or provider financial documentation
• Strong understanding of healthcare reimbursement systems including Medicare and Medicaid
• Ability to review and interpret medical billing codes and documentation
• Strong written and analytical reporting skills
• Proficiency with Microsoft Office applications including Excel and Word
• Ability to pass a federal background investigation

• Highly Preferred QualificationsExperience supporting healthcare fraud investigations within a federal or state government environment
• Experience working with investigative or litigation support tools such as Relativity, CaseMap, or similar platforms
• Professional certifications such as
• Certified Fraud Examiner (CFE)
• Certified Public Accountant (CPA)
• Healthcare compliance or auditing certifications
• Experience working with federal investigative agencies or healthcare fraud enforcement initiatives

• Ideal Candidate BackgroundFormer healthcare fraud investigator
• Healthcare fraud auditor
• Financial investigator with healthcare experience
• Former federal agent or investigator with healthcare fraud experience
• Healthcare compliance or forensic accounting professional

• Work EnvironmentThis position supports a federal investigative environment and requires collaboration with attorneys, investigators, and analysts working on complex healthcare fraud cases.
• The role requires strong attention to detail, the ability to work with sensitive information, and the ability to analyze large volumes of financial and healthcare data.