Special Investigation Unit Investigator III (ATL)

Special Investigation Unit Investigator III - Healthcare 
Remote opportunity - West Coast Hours 
Pay Rate: $42.00-55 per hour
Contract Opportunity 16 Weeks

Company Overview

The Intersect Group is partnering with a mission driven healthcare organization dedicated to expanding access to quality care for underserved populations. This organization operates at scale, supporting millions of members while advancing equity, accountability, and innovation across public health programs. Their commitment to integrity and responsible stewardship of resources creates a meaningful environment for professionals focused on compliance, analytics, and investigative excellence.

Role Summary

The Special Investigation Unit Investigator III plays a critical role in protecting healthcare program integrity through the investigation of complex fraud, waste, and abuse cases. This position leads high impact investigations involving significant financial exposure and sensitive regulatory matters.

You will analyze data, conduct detailed investigations, and collaborate with internal teams and external agencies to identify suspicious activity and support enforcement actions. The role also serves as a subject matter expert, mentoring junior investigators and strengthening investigative processes.

Key Responsibilities

• Lead complex healthcare fraud investigations involving providers, members, and vendors across multiple service lines

• Analyze claims data and billing patterns to identify irregularities and potential abuse using advanced analytical techniques

• Conduct interviews, audits, and fact finding activities to support case development and conclusions

• Prepare detailed investigative reports and documentation for internal leadership and regulatory agencies

• Partner with legal and law enforcement entities and support case referrals as required

• Serve as a subject matter expert and mentor investigators through training and guidance

• Support recovery efforts by initiating overpayment recoupment processes

• Contribute to process improvements and proactively identify emerging fraud trends

Key Requirements

• Minimum 5 years of healthcare fraud investigation or detection experience across areas such as pharmacy, DME, behavioral health, dental, hospice, or home health

• Strong data analysis capabilities including experience with large datasets, pivot tables, and advanced Excel functions

• Proven experience conducting investigations, interviews, and developing defensible conclusions

• Knowledge of healthcare regulations including Medicaid and Medicare guidelines

• Proficiency in Microsoft Word and Excel with the ability to document findings clearly and accurately

• Excellent analytical thinking and problem solving skills with attention to detail

• Strong written and verbal communication skills with the ability to present findings to diverse audiences

• Ability to manage multiple priorities, work independently, and mentor junior team members

Preferred Qualifications

• Certified Fraud Examiner or Accredited Healthcare Fraud Investigator designation

• Experience across multiple healthcare specialties

• Familiarity with Microsoft Access

• Bilingual capabilities in Spanish or other commonly spoken languages

Call to Action

If you are an experienced investigator looking to make an impact in a high visibility role, The Intersect Group invites you to apply today. Share your resume and contact information to be considered for immediate review.