Northrop Grumman Technology Services Sector is seeking a Senior Fraud Investigator to join our team of qualified, diverse individuals in transforming the future of health and human services technology for modernization of systems in the States. This position will become part of Northrop Grumman's Health and Social Service Solutions Operating Unit located in Providence, Rhode Island.
Roles and Responsibilities:
- Review and analyze State Medicaid program data (protected and sensitive) to identify high-risk or suspicious provider/beneficiary behavior that may result in loss to the program
- Research, review, and analyze current and emerging trends and techniques used in detection and investigation of fraud in government programs
- Provide subject matter expertise in the realm of Medicaid and other public benefit programs to continue to develop the most modern and comprehensive fraud detection service to the client.
- Collaborate with client to design, review, and assess analytics and other tools supporting the detection, investigation and enforcement of fraud in government programs
- Liaison with government teams of Investigators, Compliance Staff, Analysts, and Auditors
- Attend client audit and investigative team meetings (virtual and in-person)
- Provide training and guidance on detection methodology and enforcement tools to clients
- Present findings in a clear and concise presentation format including word, excel, power point
- Effectively communicate with appropriate outside authorities, client audit managers, audit staff, and compliance staff regarding investigation, compliance activities, and potential fraud case inquiries
- Engage in internal business development activities as directed.
- 10 years of experience and a Bachelor's degree in Criminal Justice, Accounting, Business Administration or another related field.
- 5 years investigative and/or audit experience with a minimum three years directly related to healthcare fraud:
- 3 years' experience in a government investigative, compliance or audit program
- 2 years' experience utilizing large data sets in an investigative or audit function
- Knowledge of CMS and HIPPA regulations as well as various other federal and state benefit programs
- Direct experience with Federal, State or Local procurement process
- Must be a US Citizen
- Proficiency with Microsoft Office suite, Internet research, public records and open source data search,
- Experience providing briefings and presentations to management and customer groups
- Strong interpersonal, communication and collaborative skills
- High ethical standards related to handling of confidential information and delivering accurate and reliable analysis and reports
- Flexibility and ability to pivot based upon client/project need
- Ability to travel on occasion
- Ability to pass extensive background investigation and complete HIPPA training and certification
- Professional certification such as CPA, CFE or AHFI
- One year direct customer engagement with Government contracts
- One year fraud detection system deployment experience
- Supervisory and project management experience
Northrop Grumman is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. For our complete EEO/AA and Pay Transparency statement, please visit www.northropgrumman.com/EEO. U.S. Citizenship is required for most positions.
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