Remote Medicaid/Medicare Program Integrity Analyst II

CoventBridge Integrity; Grove City (OH); Hybrid; USD 70,000 - 77,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Life & LTD/STD

401(k) match

Paid time off

Tuition assistance

Job summary

CoventBridge Integrity Systems is seeking a Medicaid/Medicare Program Integrity Analyst II for a REMOTE role based in Grove City, OH. You will evaluate leads, complaints, and investigations to verify potential fraud and determine appropriate actions, supporting our mission to improve healthcare delivery.

You will conduct independent reviews, analyze Medicare/Medicaid claims data, and develop fraud alerts while collaborating with CMS, state agencies, and law enforcement.

Qualifications

• High school diploma or GED; college/technical degree preferred (e.g., Criminal Justice, Statistics, Data Analysis).
• At least 1 year of experience in Program Integrity investigation or related field.
• Candidates with Certified Fraud Examiner (CFE) certifications will be given priority.
• Strong research, analysis, and decision-making abilities.

Responsibilities

• Evaluate leads, complaints, and investigations to determine need for further action.
• Conduct independent reviews of potential fraud or abuse cases.
• Use data analysis to detect aberrancies in Medicare/Medicaid claims.
• Review claims data to identify provider billing patterns and fraud risks.
• Prepare fraud alerts and communicate findings to CMS and state agencies.
• Mentor/train new Program Integrity staff.

Skills

Research

Organization

Time management

Verbal communication

Written communication

Independent work

Multitasking

Statistics

PC skills

Education

High School Diploma or GED

Criminal Justice

Statistics

Data Analysis

Certified Fraud Examiner (CFE) preferred

Job description

CoventBridge Integrity Systems is seeking a Medicaid/Medicare Program Integrity Analyst II for a REMOTE role based in Grove City, OH. You will evaluate leads, complaints, and investigations to verify potential fraud and determine appropriate actions, supporting our mission to improve healthcare delivery.

You will conduct independent reviews, analyze Medicare/Medicaid claims data, and develop fraud alerts while collaborating with CMS, state agencies, and law enforcement.