Remote Fraud Audit & Investigations Analyst

Public Partnerships | PPL; New York (NY); À distance; USD 78 000 - 99 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Fraud investigations

Audit quality

LHCSA ops

MCO compliance

CDPAP knowledge

RFI readiness

Written communication

Case/documentation

Confidential handling

Formation

Bachelor's degree preferred

Description du poste

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.