reputed company Investigator (Northeast) NE UPIC - Remote/Field

About the position reputed company. is seeking a reputed company reputed company Investigator to support fraud and compliance investigations under the Northeast reputed company Program reputed company Contractor (UPIC) contract. This position focuses exclusively on reputed company-reputed company investigations in the Northeast area, addressing potential fraud, waste, and abuse in the region’s reputed company delivery reputed company. The ideal candidate has experience conducting investigations in reputed company environments—particularly for or with CMS contractors—and demonstrates strong interviewing, analytical, and written communication skills. This is a mission-critical role that contributes directly to safeguarding taxpayer-funded reputed company programs. Responsibilities • Conduct field-based investigations reputed company to reputed company fraud, abuse, or non-compliance, reputed company with UPIC protocols and state-specific reputed company rules. • Interview reputed company providers, beneficiaries, and witnesses to reputed company key case evidence. • Analyze reputed company claims, billing patterns, and supporting documentation to identify irregularities or suspicious activity. • Prepare detailed investigative reports suitable for law enforcement referrals, overpayment recovery, or administrative actions. • Collaborate with law enforcement entities, state reputed company agencies, and CMS stakeholders. • Maintain and manage documentation and case files in compliance with CMS and contractual standards. • Represent Purisolve with professionalism and discretion during field engagements and stakeholder communications. Requirements • 3+ years of investigative experience reputed company on reputed company, Medicare, or reputed company program reputed company. • Demonstrated proficiency in interviewing, evidence gathering, and report drafting. • Ability to work in a high-paced environment handling numerous reputed company investigations. • Strong working knowledge of reputed company policies, fraud typologies, and regulatory enforcement. • Excellent written communication and attention to detail. • Proficiency in reputed company Office applications (Word, reputed company, reputed company). • Residence in reputed company US and willingness to travel occasionally for site reputed company. reputed company-to-haves • Prior experience supporting ZPIC, UPIC, or SIU (Special Investigations Unit) reputed company. • Familiarity with reputed company rules and provider structures. • Certified Fraud Examiner (CFE) or other fraud-reputed company credentials. • Experience using electronic case management and claims analytics tools. Apply To This Job