Marketplace Investigator

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Marketplace Investigator based in United States.

This remote opportunity supports critical healthcare program integrity efforts by investigating compliance risks, analyzing data, and protecting consumers within public health insurance programs. The Marketplace Investigator plays an important role in identifying potential fraud, waste, and abuse while helping ensure adherence to regulatory requirements. The position combines research, investigative analysis, documentation, and stakeholder communication to support informed decision-making. Working alongside policy experts and data analysts, this role contributes to improving oversight processes and strengthening marketplace operations. The ideal candidate is detail-oriented, analytical, and motivated by work that has a direct impact on healthcare access and accountability. This position offers the flexibility of remote work while contributing to complex, mission-focused initiatives in a collaborative environment.

Accountabilities:: The Marketplace Investigator is responsible for conducting investigations, analyzing information, and preparing recommendations related to healthcare marketplace compliance activities. The role requires strong analytical judgment, attention to detail, and the ability to manage sensitive information while following established procedures.

Conduct research, analysis, and outreach activities to support marketplace program integrity investigations.

Review documents, records, and data related to insurance agent, broker, consumer enrollment, and compliance activities.

Analyze enrollment data and identify potential fraud, waste, abuse, or regulatory compliance concerns.

Review documentation submitted by agents and brokers in response to registration, suspension, or termination actions and develop recommendations based on findings.

Apply applicable policies, regulations, and procedures when evaluating investigation results.

Develop investigative plans, case summaries, and supporting documentation as needed.

Maintain detailed records of investigative activities within case management systems.

Conduct interviews with consumers, complainants, agents, brokers, and other stakeholders when required.

Support reporting activities, workflow improvements, and operational recommendations.

Collaborate with subject matter experts, analysts, and external partners to achieve investigation goals.

Safeguard personally identifiable information (PII) and protected health information (PHI) throughout all activities.

Requirements:

The ideal candidate brings experience in healthcare programs, regulatory analysis, investigations, or data review, with strong organizational and communication skills.

Bachelor’s degree or equivalent experience in healthcare, public policy, business, or a related field.

2+ years of experience with ACA, Medicaid, Medicare, or healthcare compliance-related programs.

Experience understanding healthcare policies, regulations, enrollment requirements, and compliance responsibilities.

Experience reviewing complex reports, analyzing data, and drawing conclusions from available information.

Knowledge or experience with fraud, waste, and abuse (FWA) investigations is preferred.

Strong problem-solving skills with the ability to evaluate information and make sound recommendations.

Excellent written and verbal communication skills, including experience conducting interviews or stakeholder outreach.

Highly organized with the ability to manage multiple priorities and meet deadlines.

Proficiency with Microsoft Office applications, particularly Word and Excel.

Ability to work independently with limited supervision while collaborating effectively within a team environment.

Ability to successfully complete required background screening, including U.S. residency verification requirements.

Benefits:

Competitive salary range of approximately $69,700 to $94,300 USD, depending on experience, location, and other factors.

Fully remote work opportunity within the United States.

Comprehensive medical, dental, and vision insurance options.

401(k) plan with company matching contributions.

Flexible work arrangements supporting work-life balance.

Paid vacation, sick leave, personal time, and company holidays.

Paid parental, military, bereavement, and jury duty leave.

Short- and long-term disability benefits.

Life, accident, and critical illness insurance options.

Professional development opportunities, including paid education and certifications.

Internal career mobility support and opportunities for professional growth.

Opportunity to contribute to meaningful healthcare oversight and integrity initiatives.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1