Medicaid Investigations Specialist

Florida; Miami (FL); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Dental and vision coverage

Retirement options

Job summary

The Agency for Health Care Administration seeks an Inspector Specialist to conduct investigations into fraud, abuse, and waste within the Florida Medicaid program. You will perform on-site visits, prepare investigative reports, and collaborate with multiple units to enforce compliance with state and federal rules.

Strong analytical and communication skills are required, along with the ability to handle sensitive information and work in a fast-paced environment.

Qualifications

• Two years of investigative, enforcement, or health care experience in a regulatory/oversight setting.
• One year of planning, organizing, and coordinating work assignments.
• One year of professional use of Word, Excel, PowerPoint, Outlook.

Responsibilities

• Conduct investigations and site visits to determine Medicaid policy violations.
• Prepare investigative summaries and write referrals to law enforcement when needed.
• Identify overpayments and analyze billing data for potential fraud or abuse.
• Collaborate with MPI units and regulatory agencies on data-driven initiatives.
• Perform pre-audit preparations and follow unit protocols.

Skills

Investigative skills

Data analysis

Written communication

Report writing

Analytical thinking

Education

Associate's degree or equivalent in health law/health science/criminal justice

Program integrity certification (preferred)

Tools

MS Word

MS Excel

PowerPoint

Outlook

Job description

The Agency for Health Care Administration seeks an Inspector Specialist to conduct investigations into fraud, abuse, and waste within the Florida Medicaid program. You will perform on-site visits, prepare investigative reports, and collaborate with multiple units to enforce compliance with state and federal rules.

Strong analytical and communication skills are required, along with the ability to handle sensitive information and work in a fast-paced environment.