(763) Senior Healthcare Fraud Investigator

Job Overview

Company Summary Arlo Solutions (Arlo) is an information technology consulting services company that specializes in delivering technology solutions.

Our reputation reflects the high quality of the talented Arlo Solutions team and the consultants working in partnership with our customers.

Job Description

The War Room uses data analytics, fraud risk assessment and fast administrative action to protect Veterans and taxpayer dollars, in line with Executive Orders 14395 and 14243.

The work gets high-level oversight and reporting to the White House, Congress, the Secretary of Veterans Affairs and the Under Secretary for Health.

The Senior Healthcare Fraud Investigator leads healthcare fraud lead and case development from day one, turning analytic leads from VA's Palantir platform into weekly, decision-ready War Room referral packages. The role is advisory and analytical.

All final decisions stay with Government personnel.

Key Responsibilities

• Company Summary Arlo Solutions (Arlo) is an information technology consulting services company that specializes in delivering technology solutions.
• Our mission is to understand and meet the needs of both our customers and consultants by delivering quality, value-added solutions.
• Our solutions are designed and managed to not only reduce costs, but to improve business processes, accelerate response time, improve services to end-users, and give our customers a competitive edge, now and into the future.
• Position Arlo Solutions is supporting the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Integrity and Compliance (OIC) in standing up and running the VHA Fraud Rapid Response Center ("VA War Room").
• The Senior Healthcare Fraud Investigator leads healthcare fraud lead and case development from day one, turning analytic leads from VA's Palantir platform into weekly, decision-ready War Room referral packages.
• Location: REMOTE - Local to Washington, DC Clearance: Minimum Background Investigation Responsibilities and/or Success Factors: Fraud Lead & Case Development: Review and validate anomalies and prioritized leads from the War Room analytics (including Provider 360, anomaly detection and network analysis).
• Referral Package Development: Build War Room referral packages with documentation that supports potential administrative actions, such as provider removals, referral holds, recoupments and referrals to oversight bodies.
• Case Management Workflow: Help design the end-to-end case workflow from intake to closure, including roles, handoffs, SLAs and escalation paths, aligned with CIRTS triage practices.

Required Skills and Qualifications

• Knowledge Transfer: Help with training materials, kaizen sessions, after-action debriefs and knowledge transfer so VA staff can run War Room operations on their own by contract end.
• Minimum Qualifications Including Certificates: Bachelor's degree in a relevant field - 8+ years of federal healthcare program integrity and fraud investigations experience, such as Medicare/Medicaid and VHA healthcare fraud referrals and case development Working knowledge of healthcare fraud law: the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law and HHS OIG exclusion authorities Strong written and verbal communication for executive-level audiences Able to pass or hold a Tier 2 / Moderate Background Investigation (MBI) Desired Qualifications: Certified Fraud Examiner (CFE) certification Current or prior VA/VHA system access, or current active VA contractor status Experience working with HHS OIG, VA OIG or other federal law enforcement on healthcare fraud referrals Experience with VA Community Care claims, CMS program integrity data or provider exclusion screening Familiarity with Palantir or similar analytics and case-management platforms Experience with CIRTS or similar compliance case-tracking systems Knowledge of GAO Green Book, OMB A-123 and Payment Integrity Act fraud risk frameworks AAP Statement We are proud to be an Affirmative Action and Equal Opportunity Employer and as such, we evaluate qualified candidates in full consideration without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, age, disability status, protected veteran status, and any other protected status.

Work Location and Schedule

This role is listed as Remote USA with location information shown as Remote USA. The employment type is Full Time.

About the Company

Arlo Solutions is the organization connected with this listing. USA Jobs Today displays this opportunity for job discovery only, so applicants should verify company details, application instructions, and eligibility on the official employer website.