Fraud Investigator - Federal Healthcare

Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization.

Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.

Work You'll Do

As a Project - Consultant, Forensics and Investigations on the project, you will address the threats that perpetuate fraud, waste, and abuse, our clients look to our team to provide the guidance and solutions required to help them stay ahead of emerging issues and protect the integrity of their programs.

Responsibilities will include:


* Work with a team of investigators responsible for developing investigations and referrals of suspected healthcare fraud for potential action.


* Utilize specialized databases, customized applications, development, and configuration management.


* Collaborate with government program representatives, law enforcement, and case teams to gather, design, and implement sound investigative and referral procedures that meet quality and evidentiary standards as required.


* Contribute to vulnerability detection, investigative workflow, quality review, and presentation of findings.


* Support AI-enabled workflows and coordinate with analytics teams for structured and unstructured data.


* Analyze health insurance claims data, open source, and public information to identify new and emerging fraud schemes and identify suspicious billing patterns or other activities indicative of potentially fraudulent behavior.


* Conduct analysis of open source and public information to identify sources of identity theft.


* Develop fraud referrals for presentation to the client, law enforcement, and other government agencies.


* Identify public health insurance program vulnerabilities through data analytics and open-source information.

The successful candidate would possess these skills:


* Ability to work independently and collaborate as part of a team


* Effective written and verbal communication skills


* Meticulous attention to detail and quality of work product


* Ability to build and sustain professional relationships


* Ability to lead projects or workstreams


* Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment


* Strong interpersonal skills and professional demeanor


* Ability to meet deadlines


* Ability to provide clear guidance to others

The Team

Deloitte's Government & Public Services (GPS) practice - our people, ideas, technology and outcomes - is designed for impact.

Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission pr...