Director, Program Integrity, Health & Human Services

KPMG LLP; City of Albany (NY); On-site; USD 180,000 - 260,000; Full time

Job summary

KPMG LLP seeks a Director, Program Integrity, Health & Human Services to join our Advisory Services practice. You will lead advisory engagements across Medicaid, SNAP, and other HHS programs, designing end-to-end program integrity frameworks and risk-based controls.

The role requires eight+ years of relevant experience, advanced credentials preferred, and travel up to 80%. You will mentor teams, lead client relationships, and contribute to thought leadership while upholding KPMG's standards.

Qualifications

• Minimum eight years of relevant experience in program integrity, compliance, audits, investigations, or FWA roles.
• Advanced degree preferred; Bachelor’s required; certifications such as CPA, CFE, CGFM or PMP valued.
• Strong knowledge of Medicaid and human services laws, regs and guidance.
• Experience designing integrity strategies, reviews, and FWA prevention/detection initiatives.
• Proven leadership of multi-disciplinary engagements and client service with BD experience.
• Willingness to travel up to eighty percent.
• Authorized to work in the U.S. without visa sponsorship now or in the future.

Responsibilities

• Provide advisory services related to program integrity, compliance, and FWA across HHS programs.
• Lead risk, gap, and fraud risk assessments and manage reviews, audits, and monitoring.
• Develop CAPs and drive continuous improvement to remediate findings.
• Translate regulatory expectations into practical operational solutions.
• Provide program integrity leadership across financial, reimbursement, and fiscal functions.
• Contribute to thought leadership and lead business development within HHS clients.
• Oversee team operations, recruitment, and talent development.

Skills

Program integrity

Compliance

FWA investigations

Leadership

Team management

Regulatory knowledge

Analytics & reporting

Education

Bachelor’s degree required

Advanced degree preferred

Certifications: CPA, CFE, CGFM, PMP

Job description

KPMG is currently seeking a Director, Program Integrity, Health & Human Services to join our Advisory Services practice.

Responsibilities:

• Provide technical and strategic advisory services related to program integrity, compliance, and fraud, waste, and abuse (FWA) across Health and Human Services (HHS) programs, including Medicaid, HR1-related programs (such as SNAP), rural health, childcare, child welfare, and child support enforcement; Support the design, implementation, and operation of end to end program integrity frameworks, including policy and procedure development, governance models, internal controls, and operating structures
• Lead and oversee risk assessments, gap assessments, and fraud risk assessments to identify program vulnerabilities and prioritize integrity and compliance activities; Direct and support compliance reviews, audits, investigations, and third party/subrecipient monitoring, including desk and field audits; design and oversee FWA prevention and detection strategies, leveraging data analytics, automated flags, trend analysis, dashboarding, and reporting
• Develop and monitor corrective action plans (CAPs) and continuous improvement efforts to remediate findings and strengthen program controls; Support provider and participant integrity activities, including credentialing, background checks, eligibility-related reviews, and forensic analysis
• Provide guidance on regulatory compliance with federal and state requirements and translate policy and regulatory expectations into practical, operational solutions; Provide program integrity leadership across financial, reimbursement, and fiscal administration functions, including rate setting, cost reporting, managed care oversight, and federal claiming, to identify and mitigate fraud, waste, and improper payments
• Contribute to KPMG’s thought leadership by authoring professional articles, participating in industry and regulatory forums, and speaking at external events on program integrity and FWA topics; as well as lead and actively participate in business development efforts, including client relationship management, proposal development, and expansion of program integrity services across HHS clients
• Oversee team operations by planning, scheduling, and assigning work; provide leadership in recruiting, developing, and retaining talent to grow the program integrity practice
• Act with integrity, professionalism, and personal responsibility to uphold KPMG’s respectful and inclusive work environment

Qualifications:

• Minimum eight years of recent and applicable experience in program integrity, compliance, audits, investigations, or FWA-related roles, supporting federal or state HHS programs, including Medicaid and/or human services programs (such as SNAP, child welfare, childcare, child support enforcement)
• Advanced degree from an accredited college or university is preferred; Minimum of a Bachelor’s degree is required; preferred certifications include CFE, CGFM, PMP, CPA or other relevant credentials
• Strong working knowledge of federal and state laws, regulations, and guidance governing Medicaid and human services programs
• Experience designing and executing program integrity strategies, compliance reviews, and FWA prevention and detection initiatives; experience in Medicaid finance, healthcare finance, reimbursement, or fiscal administration, including roles such as Medicaid CFO, Deputy CFO, finance director, or consulting roles supporting state HHS or Medicaid agencies
• Demonstrated experience with Medicaid rate setting, cost reporting, managed care financial oversight, federal claiming, or financial audits, and their intersection with program integrity and compliance.
• Demonstrated experience leading teams and managing complex, multi-disciplinary engagements, with an active role in execution and delivery; proven success in client service and business development within an advisory or consulting environment; exceptional interpersonal and communication skills, with the ability to build credibility and trust with senior government and organizational leaders
• Willingness to travel as needed, which may be up to eighty percent
• Applicants must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. KPMG LLP will not sponsor applicants for U.S. work visa status for this opportunity (no sponsorship is available for H-1B, L-1, TN, O-1, E-3, H-1B1, F-1, J-1, OPT, CPT or any other employment-based visa)