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Fraud Investigator II



Accounting & Finance
Posted on Friday, October 27, 2023

About Us

We are a very profitable and fast-growing healthcare startup—a small and mighty team of 185 helping people find and enroll in ACA health coverage. We are the largest ACA enrollment platform, after, having helped over 15 million people enroll in health coverage. We're a mission-driven team who advocates for and cares deeply about the people we serve.

We're a double bottom-line company: revenues and enrollments in ACA coverage. The ACA brings high-quality, comprehensive, and affordable health coverage within reach for low-income Americans and we exist to make that promise a reality. Your contribution will help hundreds of thousands of people navigate the complex and confusing health insurance industry and enable them to access health care when they need it.

We are committed to building a team balanced in representation to best serve the people who use our products. We believe in creating inclusive and equitable spaces, which build trust and respect and foster a sense of belonging. These values are at the core of our culture, and we genuinely believe they will continue to lead our organization to successful outcomes.

About the Role

HealthSherpa is looking for a Fraud Investigator II to join our Fraud Prevention Team. You will investigate instances of fraud and ensure that all marketplace participants comply with rules and regulations set by health insurance companies and government entities. You will report to the Manager, Fraud Prevention.

The base salary range is $60,000-$70,000 + equity + benefits. Within the range, individual pay is determined by multiple factors, including job-related skills and experience.

You Will:

  • Manage daily intake of fraud cases by overseeing multiple queues and prioritizing high risk cases

  • Investigate unusual behavior to detect fraudulent or noncompliant activity and discover new fraudulent trends

  • Investigate fraud allegations and complaints by reaching out to agents, members, and other parties by phone and mail to gather information or request more evidence

  • Use SQL, spreadsheet data, and BI tools to query and present Fraud Prevention data

  • Prepare all-encompassing investigative reports with your findings

  • Create and execute new processes that enhance our fraud prevention unit

  • Collaborate with partners on our Policy, Legal, Engineering and Support teams to resolve complex issues

You Have:

  • 2-3 years experience in Healthcare, Insurance, Fraud, or Compliance

  • Basic SQL and data analysis knowledge (with BI tools and Google Sheets)

  • Experience with professional or formal writing (including investigative reports, case summaries, audit trail documents, and/or standard operating procedures)

  • Bonus: ACA/Marketplace/Medicaid/Medicare Knowledge, experience dealing with Confidential Data (PII, PCI, HIPAA), Bilingual (English/Spanish)

What We Offer (Full-time, Not Temporary/Not Seasonal)

  • Remote-first company (US-based remote only)

  • Great compensation package at a high-growth, profitable company

  • Excellent benefits package that includes health, vision, and dental coverage for you, your spouse, and dependents

  • HSA/FSA options with corresponding contribution limits

  • Monthly grocery stipend and home internet reimbursement

  • 401K w/ a match after a grace period

  • Life and AD&D coverage

  • Disability insurance (Short and Long Term)

  • Parental leave

  • Four (4) weeks of paid vacation in addition to paid holidays

  • Home office budget for remote team members

  • Mental health and other wellbeing support programs through a partner network

We welcome and encourage people of diverse backgrounds, experiences, identities, abilities, and perspectives to apply. We are an equal opportunity employer and a fun place to work. Come join the team at HealthSherpa! #LI-Remote