Medicaid Investigations Team Lead

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. 

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

The Investigations Team Lead manages complex fraud investigations requiring advanced investigative techniques, multi-party coordination, and potential criminal referrals. This position demands law enforcement experience, investigative acumen, and the ability to build cases suitable for prosecution. The Team Lead works closely with the Medicaid Fraud Control Unit and other law enforcement agencies on high-priority cases.

• Lead complex fraud investigations of providers, members, and organized fraud schemes
• Supervise investigation team and assign cases based on complexity and expertise
• Develop investigation plans and coordinate multi-disciplinary investigative activities
• Conduct field investigations including provider interviews and site visits
• Analyze complex billing patterns and identify organized fraud schemes
• Prepare comprehensive investigation reports and evidence packages
• Coordinate with MFCU on criminal referrals and prosecutions
• Liaise with law enforcement agencies including FBI, OIG, and DEA as appropriate
• Provide testimony in administrative and legal proceedings
• Identify emerging fraud trends and recommend new detection strategies
• Manage sensitive and confidential investigations with discretion
• Participate in quarterly business planning and fraud trend analysis

Required Qualifications

• Bachelor's degree in Criminal Justice, Law Enforcement, Healthcare Administration, or related field
• CFE (Certified Fraud Examiner) certification strongly preferred
• Additional fraud-related certifications valued
• Minimum 5 years of investigative experience in healthcare fraud, law enforcement, or similar field
• Minimum 3 years of supervisory or team lead experience
• Proven track record of successful fraud investigations leading to recovery or prosecution
• Experience coordinating with law enforcement agencies and prosecutors
• Background in Medicaid fraud investigations highly preferred

Knowledge and Skills

• Expert knowledge of investigative techniques and evidence gathering
• Understanding of healthcare fraud schemes and criminal statutes
• Familiarity with False Claims Act, Anti-Kickback Statute, and related laws
• Strong interviewing and interrogation skills
• Excellent report writing and documentation abilities
• Experience with surveillance and field investigation techniques
• Analytical thinking and pattern recognition capabilities
• Leadership and team coordination skills

Other Requirements

• Full-time dedication to Indiana contract
• Available for field work and in-person meetings as required
• Successfully pass comprehensive background check
• Subject to State approval
• Valid driver's license and willingness to travel within Indiana

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting accommodation, all applications must be submitted through our online application system.