Remote Fraud Investigations & Compliance Analyst

Public Partnerships | PPL; United States; Remote; USD 63,000 - 83,000; Full time

Job summary

Public Partnerships LLC is seeking a Fraud Audit & Investigations Specialist to provide administrative and analytical support to the FWA Analyst and Senior Manager, Program Integrity, in conducting fraud, waste, and abuse investigations. Remote with occasional travel, the role assists intake, documentation, and tracking, and helps prepare regulator-ready case files.

The position requires 2–3 years of relevant experience, a Bachelor’s degree preferred, and strong organizational skills to maintain

Qualifications

• 2-3 years of combined experience across LHCSA, MCO/health plan, and/or state regulatory Medicaid roles.
• Prior experience in fraud investigations, program integrity, or compliance auditing preferred.
• Experience preparing or responding to regulatory RFIs, audits, or CAP documentation preferred.
• Experience with consumer-directed care programs (e.g., CDPAP) strongly preferred.

Responsibilities

• Support standard and moderate-complexity investigations into suspected fraud, waste, & abuse from various sources.
• Make routine outbound calls to providers, consumers, caregivers, agencies, and health plans to gather information.
• Review conduct against program requirements, including CDPAP issues.
• Coordinate with analytics, compliance, legal, and account management to drive case resolution.
• Recognize and elevate high-risk or legally sensitive matters to leaders.
• Assemble and organize case files and supporting documentation for regulatory sufficiency.
• Pull and analyze conflict reports to identify scheduling overlaps and resolve discrepancies.
• Run and distribute daily/recurring reports and provide general team support.
• Assemble documentation for RFIs from regulators and audits under supervision.
• Maintain RFI tracking log with status updates and deadlines.
• Coordinate with Legal, Compliance, Risk & Assurance, and Operations to gather data for cases.
• Support preparation for external audits and assessment requests.

Skills

Organizational skills

Documentation

Multitasking

Written communication

Discretion

Phone outreach

Cross-functional collaboration

Education

Bachelor’s degree preferred

2-3 yearsLHCSA/Medicaid experience

Job description

Public Partnerships LLC is seeking a Fraud Audit & Investigations Specialist to provide administrative and analytical support to the FWA Analyst and Senior Manager, Program Integrity, in conducting fraud, waste, and abuse investigations. Remote with occasional travel, the role assists intake, documentation, and tracking, and helps prepare regulator-ready case files.

The position requires 2–3 years of relevant experience, a Bachelor’s degree preferred, and strong organizational skills to maintain