Remote Medicaid Fraud & Investigations Specialist

Pplfirst; United States; Remote; USD 78,000 - 99,000; Full time

Job summary

Public Partnerships LLC is seeking a Fraud Audit & Investigations Analyst to lead investigations into fraud, waste, and abuse within Medicaid programs. You will audit case files, prepare regulator-ready materials, and coordinate responses to RFIs from OMIG, MFCUs, and health plans.

Ideal candidates have 5–7 years across LHCSA, MCO/health plan, or state regulatory Medicaid roles, with strong documentation skills and ability to work remotely with occasional travel.

Qualifications

• Experience investigating and/or auditing fraud, waste, and abuse in Medicaid or healthcare.
• Familiarity with LHCSA operations, MCO/health plan compliance, or SIU functions.
• Knowledge of Medicaid requirements, including CDPAP.
• Strong organizational and documentation skills for regulator-ready materials.
• Ability to manage multiple investigations and RFIs under deadlines.
• Strong written communication and discretion with confidential information.
• Ability to collaborate across Legal, Compliance, Risk, and Operations.

Responsibilities

• Conduct and support investigations into suspected FWA.
• Interview witnesses and preserve evidence per standards.
• Prepare case summaries and referrals for regulators.
• Perform quality control of case files and regulatory docs.
• Lead compilation of RFI responses and ensure timely submissions.
• Coordinate with Legal, Compliance, Risk, and Operations.
• Maintain tracking logs for RFIs and audits.

Skills

FWA investigations

Medicaid knowledge

LHCSA operations

MCO/health plan compliance

CDPAP familiarity

Regulatory RFIs

Education

Bachelor's degree preferred

Experience substitution possible

Tools

Regulatory document management

Job description

Public Partnerships LLC is seeking a Fraud Audit & Investigations Analyst to lead investigations into fraud, waste, and abuse within Medicaid programs. You will audit case files, prepare regulator-ready materials, and coordinate responses to RFIs from OMIG, MFCUs, and health plans.

Ideal candidates have 5–7 years across LHCSA, MCO/health plan, or state regulatory Medicaid roles, with strong documentation skills and ability to work remotely with occasional travel.