Healthcare Fraud Investigator

Job description

**Council Capital is a healthcare-focused private equity firm based in Nashville, Tennessee, managing over $350 million in committed capital.** We invest in lower middle market healthcare companies where we see the potential to scale purpose and performance. Our investments span control and minority positions in businesses with enterprise values between $10 million and $100 million. What sets us apart is the **Council Model**—a proven framework that surrounds founders and leadership teams with a powerful combination of support: our **CEO Council** of seasoned operators, our **Strategic Healthcare Investors** who bring real-world insight and access, and our internal **Value Creation Team**, focused on enabling growth through talent, systems, and strategy. At Council Capital, we’re not just backing companies—we’re helping build enduring businesses that improve lives and shape the future of healthcare. **About Alivia** Alivia Analytics helps healthcare payers find and recover improper payments. Our payment integrity platform pairs analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid, Commercial, and FEP lines of business, returning significant value to the clients we serve. We are scaling our service organization to keep pace with new client demand, and this role is part of that build-out. **The Role** This is a hunt-and-close role. You will identify and qualify improper-payment leads, then own each one end to end, from concept through an accepted case to recovered dollars. You will carry a live caseload, drive it to closure, and be measured on the revenue you return. You will work directly with payer clients and partner with coders and customer success, but you will not manage anyone. Strong investigators here come from healthcare payer/vendor backgrounds or from investigative and law-enforcement backgrounds paired with real healthcare-claims depth. **What You Will Do** - Identify and qualify 100%+ of budgeted leads each month (roughly 15), taking each from concept to an accepted lead. - Earn at least 50% lead acceptance/concept approval from clients. - Carry an active caseload of 20 to 30 cases per month, owning each case from open to close. - Close 90% of individual cases within four to five months. - Convert case value into recovered dollars, hitting at least 100% of your top-line revenue target (roughly 45% of identified value converting to gross revenue). - Maintain a 95% first-time acceptance rate on documentation sent to customers. - Keep payer complaints at zero and minimize provider abrasion across every interaction. - Work fluently across Medicare, Medicaid, Commercial, and FEP lines of business. **What You Bring** - 2+ years at a healthcare payer or vendor as an Investigator or Auditor working with healthcare claims. - Experience across multiple lines of business (Medicare, Medicaid, Commercial, FEP). - Proficiency with auditing software, case management systems, and claims systems. - Experience owning the full investigation workflow, from lead to revenue. - Sound analytical judgment and the ability to negotiate favorable, defensible outcomes. - U.S.-based with work authorization (no offshore; PHI environment). **Nice to Have** - Certified Fraud Examiner (CFE). - Certified Professional Coder (CPC). - Accredited Health Care Fraud Investigator (AHFI). - Certified Anti-Fraud Professional (CAFP). - Based in an Eastern or Central time zone. **Council Capital and our portfolio companies are committed to building high-performing teams by hiring the best talent—period.** We believe in putting the right people in the right seats, regardless of background, and we’re always looking for individuals who bring fresh thinking, grit, and a drive to make a difference. Thank you for considering a role with one of our companies. We’re excited to learn more about you.