Fraud Audit & Investigations Analyst

Public Partnerships | PPL; New York (NY); Remote; USD 78,000 - 99,000; Full time

Job summary

Public Partnerships LLC, a leading Medicaid Financial Management Service provider, seeks a Program Integrity Fraud Audit & Investigations Analyst to oversee FWA investigations, quality control, and regulatory deliverables. You will collaborate with regulators, health plans, and internal teams to ensure compliance and case readiness.

The role involves remote work with occasional travel, handling RFIs, and supporting external audits.

Qualifications

• Experience across LHCSA, MCO/health plan, and state regulatory Medicaid roles.
• 5-7 years in fraud investigations, program integrity, or compliance auditing.
• Experience preparing or responding to regulatory RFIs, audits, or CAP documentation.
• CDPAP experience strongly preferred.

Responsibilities

• Conduct investigations into suspected fraud, waste, abuse, neglect, and exploitation.
• Perform quality control review of case files and regulatory submissions.
• Manage RFIs and regulatory deliverables, ensuring accuracy and timeliness.
• Partner with Legal, Compliance, Risk & Assurance, Operations on investigations and audits.
• Support relationships with regulators, MFCUs, and law enforcement partners.

Skills

Fraud investigations

Audit quality

LHCSA ops

MCO compliance

CDPAP knowledge

RFI readiness

Written communication

Case/documentation

Confidential handling

Education

Bachelor's degree preferred

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing!We're committed to bringing passion and customer focus to the business.Our people make all the difference in our success.

Public Partnerships LLC supports individuals with disabilities or chronic illnesses and aging adults, to remain in their homes and communities and “self” direct their own long-term home care. Our role as the nation’s largest and most experienced Financial Management Service provider is to assist those eligible Medicaid recipients to choose and pay for their own support workers and services within their state-approved personalized budget. We are appointed by states and managed healthcare organizations to better serve more of their residents and members requiring long-term care and ensure the efficient use of taxpayer funded services. Our culture attracts and rewards people who are results-oriented and strive to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, entrepreneurial environment, and who want to make a difference in helping transform the lives of the consumers we serve. (learn more at www.pplfirst.com).

Job Summary

The Program Integrity Fraud Audit & Investigations Analyst conducts fraud, waste, and abuse (FWA) investigations and serves as the team's lead for quality control and regulatory deliverable readiness. This role investigates suspected FWA, audits and quality-checks case files and referral packages for completeness and regulatory sufficiency and owns the preparation and packaging of materials in response to Requests for Information (RFIs) from regulators, health plans, and law enforcement. With a broad view of the Medicaid ecosystem, spanning LHCSA/provider agency operations, MCO/health plan processes, and regulator expectations, this person ensures investigations and audit deliverables meet the standards of OMIG, MFCUs, health plan partners, and other oversight bodies.

Key Responsibilities

InvestigationsConduct and/or support investigations into suspected fraud, waste, abuse, neglect, and exploitation referred from analytics, hotline reports, or health plan/regulator referralsInterview witnesses, gather and preserve evidence, and document findings in accordance with investigative standards and chain-of-custody practicesAssess provider, consumer, and caregiver conduct against program requirements, including CDPAP-specific issues such as attestations, relationship restrictions, and EVV compliancePartner with the analytics function to validate and further develop data-driven leads into case-ready findingsPrepare case summaries, findings, and referral recommendations for the Senior Director and, as applicable, external agencies

Audit & Quality ControlPerform quality control review of case files, referrals, and investigative documentation for completeness, accuracy, and regulatory sufficiencyAudit adherence to internal investigative protocols, SOPs, and documentation standardsAnalyze documentation and operational processes to assess compliance with established requirements, identify potential risks, and propose solutions for process improvements.Identify and remediate documentation gaps prior to internal sign-off or external submissionSupport internal audit-readiness reviews of the Program Integrity function

RFI & Regulatory Deliverable ManagementServe as the lead for compiling, organizing, and quality-checking response packages for Requests for Information from MFCUs, OMIG, health plans, and other regulators or auditorsEnsure RFI responses are complete, accurate, well-organized, and appropriately documented; track deliverables and timelines to support timely submission and resolution.Coordinate cross-functionally (Legal, Compliance, Risk & Assurance, Operations) to gather required documentation and dataMaintain a tracking log of all open and closed RFIs, including status, owners, and deadlinesSupport preparation for external audits and assessment requests in partnership with the Risk and Assurance team

Stakeholder & Ecosystem PartnershipServe as a subject matter expert with working knowledge of LHCSA agency operations, MCO/health plan compliance and SIU functions, and state regulator expectationsPartner with MCO/health plan SIU and compliance counterparts on shared investigations and referral processesSupport the Senior Director in maintaining relationships with regulators, MFCUs, and law enforcement partnersProvide the frontline and health plan perspective when designing or refining investigative and audit processes

All other duties assigned

Required Skills

Demonstrated experience investigating and/or auditing fraud, waste, and abuse in a Medicaid or healthcare settingFamiliarity with LHCSA agency operations, MCO/health plan compliance or SIU functions, and state or federal regulator expectations; experience across more than one of these perspectives is a strong plusWorking knowledge of Medicaid program requirements, including consumer-directed care programs (e.g., CDPAP)Excellent organizational and documentation skills; comfortable assembling audit-ready, regulator-facing materialsAbility to manage multiple investigations, audits, and RFIs simultaneously under deadline pressureStrong written communication skills; able to produce clear, defensible, and professional case and audit documentationSound judgment and discretion when handling sensitive or confidential informationComfortable partnering across compliance, legal, operations, and external stakeholders

Qualifications

Education:Bachelor's degree preferred; substantial professional experience may be considered in lieu of a formal degree.Substantial professional experience in a related field may be considered in lieu of formal degree.

Experience:5-7 years of combined experience across LHCSA, MCO/health plan, and/or state regulatory Medicaid rolesPrior experience in fraud investigations, program integrity, or compliance auditing requiredExperience preparing or responding to regulatory RFIs, audits, or CAP documentation preferredExperience with consumer-directed care programs (e.g., CDPAP) strongly preferred

Certification: CFE, AHFI, or CCEP preferred but not required.

Working Conditions

Remote work with occasional business travel

Supervisory Responsibility

(If applicable):None (individual contributor); TBD as team scales.

Compensation

$77,500 - $99,000

This role is eligible for a base salary within the posted range.

Actual compensation will be determined based on a variety of factors, including skills, experience, and geographic location.

Compensation may vary for positions based in high cost-of-labor markets.

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified

PPL is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion.

We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences.

At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.

We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law.

PPL will not tolerate discrimination or harassment based on any of these characteristics.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!