Supervisor - Field Audit/Investigation

Accountabilities: Oversee audits and investigations, manage incoming leads, assign cases to auditors and investigators, and establish appropriate priorities and workloads. Review audit and investigation plans, operational strategies, case files, requests for information, reports, and correspondence to ensure quality, completeness, and alignment with established criteria. Conduct and supervise investigative activities, including interviews, onsite audits and investigations, site verification, and coordination with law enforcement when required. Lead complex audit and investigation projects by developing strategies, coordinating stakeholder meetings, monitoring investigative actions, and documenting findings for management. Evaluate potential fraud, waste, abuse, and compliance matters against established criteria and determine appropriate courses of action with auditors and investigators. Review and approve investigative findings, closing summaries, administrative remedies, and case materials prepared for customer and stakeholder presentations. Coordinate with senior leadership, data and medical review teams, regulatory agencies, law enforcement, and other program integrity organizations to support efficient case resolution. Present or assist with presenting findings to regulatory agencies and law enforcement for potential further investigation, prosecution, or administrative action. Supervise administrative remedies such as payment suspensions, provider or retailer education, revocations, and other actions as directed by customers. Collect and provide documentation requested by internal and external stakeholders, including regulatory agencies, law enforcement, and FOIA-related requests. Maintain accurate case tracking records covering interviews, events, findings, communications, and file reviews. Prepare teams and case materials for customer meetings and quality assurance reviews, including major case coordination activities. Testify at legal or administrative proceedings when required. Manage team performance through regular feedback, formal performance reviews, coaching, engagement, motivation, and professional development. Requirements Bachelor’s degree required; equivalent experience may be considered where applicable. 5–7 years of relevant experience required, with 8–11 years preferred. Experience overseeing audits, investigations, compliance reviews, or program integrity activities involving government programs such as Medicare, Medicaid, or SNAP. Strong knowledge of fraud, waste, and abuse investigations and the ability to evaluate cases against established referral and compliance criteria. Experience leading or supervising auditors, investigators, or similar investigative professionals. Strong judgment and decision-making skills, particularly when handling complex, sensitive, or potentially high-risk cases. Ability to develop investigation strategies, assess evidence, review findings, and determine appropriate next steps. Strong written and verbal communication skills, with the ability to present complex investigative findings clearly to internal and external stakeholders. Ability to collaborate effectively with senior leadership, regulatory agencies, law enforcement, data and medical review teams, and other program integrity partners. Strong organizational skills and attention to detail, particularly when managing multiple cases, documentation requirements, deadlines, and stakeholder requests. Ability to work independently, prioritize competing demands, and escalate questions or issues appropriately. Experience with case tracking systems and investigative documentation processes. Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-Fraud Investigator (AHFI) certification preferred. Benefits Annual salary range of $49,714–$95,000 , depending on applicable factors. Full-time salaried position. Remote work opportunity within the United States. Opportunity to lead investigative and program integrity activities with meaningful impact on government healthcare and assistance programs. Professional development through team leadership, complex investigations, stakeholder engagement, and regulatory collaboration. Equal employment opportunity workplace. Employment offers are contingent upon successful completion of required pre-employment background and drug screening.