Medicare Investigator – Miami-Dade / Broward Area

Job Summary:
Purisolve, Inc. is seeking an experienced Medicare Investigator to join our team, supporting high-impact healthcare fraud and compliance initiatives in Miami-Dade and Broward County, Florida. This role is responsible for conducting in-depth investigations into potential Medicare fraud, abuse, or non-compliance by interviewing providers and beneficiaries, analyzing documentation and claims data, and drafting formal investigative reports.

The ideal candidate brings a background in healthcare or law enforcement investigations, with exceptional written communication skills, professional demeanor in interviews, and a sharp eye for identifying anomalies or patterns in Medicare claims.

Responsibilities:

• Conduct field-based investigations in alignment with CMS and federal fraud detection protocols.
• Interview healthcare providers and Medicare beneficiaries to gather case-specific evidence.
• Analyze claims, billing data, and supporting documentation to identify irregularities and potential fraud.
• Draft comprehensive investigative reports suitable for use in administrative or legal proceedings.
• Coordinate with law enforcement and compliance entities as needed.
• Maintain documentation and case files in accordance with federal and contractual standards.
• Represent Purisolve professionally during all investigative interactions.

Minimum Qualifications:

• 3+ years of investigative experience in healthcare, Medicare fraud, or law enforcement roles.
• Demonstrated expertise in interviewing techniques and information gathering.
• Strong writing and documentation skills with experience drafting investigative reports.
• Familiarity with Medicare regulations, fraud typologies, and compliance protocols.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and basic case tracking systems.
• Local residency in Miami-Dade or Broward County, FL, or willingness to travel within the region.
• High school diploma and 7+ years relevant experience, or equivalent combination of education and experience per the matrix below.

Preferred Qualifications:

• Experience working with CMS contractors (e.g., ZPICs, UPICs, MACs).
• Knowledge of federal and state healthcare regulations.
• Certified Fraud Examiner (CFE) or related investigative certification.
• Experience using tools for claims data analysis or documentation review.

Salary & Work Structure:

• Salary Target: $70,000 (preferred range; subject to qualifications and budget constraints)
• Work Type: Remote/Work from home with some Field-based work within South Florida
• Schedule: Full time, Monday – Friday (standard business hours)

Education:
We will consider any of the following:

• High school degree with seven (7) years of experience
• Associate's degree with five (5) years of experience
• Bachelor's degree with two (3) experience
• Master's degree with one (1) year experience

About Our Company:
Purisolve, Inc. is a professional services consulting firm specializing in client solutions to improve information management, data analytics, and business intelligence. We are committed to helping our clients become strategic data-driven organizations to increase revenues, reduce costs, or improve efficiencies.

Our firm name, Purisolve, was derived by combining two words: "purity" and "solutions". The word "purity" represents unblemished integrity, including professionalism and work ethic, which is a core value of our firm. The word "solutions" is a simple term that represents innovation and customer-focused results for solving problems.

Purisolve was founded in 2007, and has had steady growth in both revenue and employees. This growth has been driven by our commitment to client service and the value we deliver.

Our team is composed of highly skilled professionals who are passionate about making a difference in the communities we serve. Through various social responsibility initiatives, we strive to give back and create a positive impact on society. Joining Purisolve means becoming part of a forward-thinking organization that values its employees. We support a healthy work-life balance and are dedicated to helping team members achieve their full potential.

Disclaimer:
Please note that initial application screenings may be conducted using AI-based tools. These tools are employed to assist in efficiently processing and evaluating applications, ensuring that all candidates are considered fairly. The AI tools are designed to assess qualifications based on the information provided in your application and resume. However, all final hiring decisions are made by our executive leadership team, ensuring a thorough and personalized evaluation of each candidate. By submitting your application, you acknowledge and agree to this process.

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