Marketplace Investigator

Position Overview

This role is for a Marketplace Investigator based in the United States, supporting vital healthcare program integrity efforts from a remote setting. The investigator’s primary focus is to detect compliance risks by examining data and safeguarding consumers involved in public health insurance programs.

Reporting within a collaborative environment, the Marketplace Investigator works closely with policy experts and data analysts to help identify potential fraud, waste, and abuse, while ensuring adherence to regulatory standards. The role involves investigative research, data analysis, documentation, and communicating findings to stakeholders to facilitate informed decisions.

Key Responsibilities

• Perform research, data analysis, and outreach to support marketplace compliance investigations.
• Examine documentation related to insurance agents, brokers, consumer enrollments, and compliance activities.
• Identify indicators of fraud, waste, abuse, or regulatory violations by analyzing enrollment data.
• Assess documentation from agents and brokers responding to registration, suspension, or termination processes and provide informed recommendations.
• Apply appropriate policies, laws, and procedural guidelines during evaluation of investigation outcomes.
• Create investigative plans, case summaries, and maintain thorough records within case management systems.
• Conduct interviews with consumers, complainants, agents, brokers, and other relevant parties as needed.
• Contribute to reporting tasks, workflow enhancements, and suggest operational improvements.
• Collaborate with subject matter experts, data analysts, and external partners to achieve investigation objectives.
• Ensure the protection of personally identifiable information and protected health information throughout investigative processes.

Qualifications and Requirements

• Bachelor's degree or equivalent experience in healthcare, public policy, business, or a related discipline.
• Minimum of two years’ experience working with ACA, Medicaid, Medicare, or healthcare compliance-related programs.
• Understanding of healthcare policies, regulations, enrollment protocols, and compliance obligations.
• Proven ability to review complex reports, analyze data effectively, and draw logical conclusions.
• Preferred experience or knowledge in investigating fraud, waste, and abuse within healthcare programs.
• Strong analytical and problem-solving capabilities to interpret information and generate sound recommendations.
• Excellent communication skills, both verbal and written, including experience conducting interviews and stakeholder engagement.
• Highly organized with capacity to handle multiple tasks simultaneously and meet deadlines.
• Proficiency in Microsoft Office suite, especially Word and Excel.
• Ability to work independently with minimal supervision while fostering teamwork.
• Successful completion of background checks, including verification of U.S. residency.

Benefits

• Competitive salary ranging roughly from $69,700 to $94,300 annually, dependent on experience and location.
• Fully remote position available within the United States.
• Extensive medical, dental, and vision insurance options.
• 401(k) retirement plan with company matching contributions.
• Flexible work schedules supporting work-life balance.
• Paid time off including vacation, sick days, personal days, and company holidays.
• Additional paid leaves including parental, military, bereavement, and jury duty.
• Short-term and long-term disability benefits.
• Life, accident, and critical illness insurance options.
• Opportunities for professional development, including funding for education and certifications.
• Support for career advancement within the organization and opportunities for professional growth.
• Chance to contribute meaningfully to healthcare oversight and integrity initiatives.