Remote Program Integrity Analyst - Medicaid Fraud Detection

HHAeXchange; United States; On-site; USD 155,000 - 165,000; Full time

Benefits offered by this job

Health plans

Paid time off

Company paid holidays

401K with company match

Job summary

HHAeXchange is seeking a Sr Program Integrity Analyst to join the growing Program Integrity function. You will identify fraud, waste, and abuse patterns in Medicaid HCBS data and translate findings into scalable detection capabilities embedded in the platform.

Work across product, engineering, and client teams, validate detection tools, and present insights to state Medicaid agencies and MCOs. Remote role for EST/CST time zones within the US.

Qualifications

• Bachelor’s degree and at least 5 years in healthcare fraud detection or related field.
• Knowledge of Medicaid operations and how providers enroll, bill, and are reimbursed.
• Ability to recognize FWA patterns and distinguish fraud, waste, and abuse in data.
• Strong analytical thinking and investigative problem-solving to trace anomalies.
• Clear, credible communication of complex findings to technical and non-technical audiences.

Responsibilities

• Analyze Medicaid claims, visit, and EVV data to detect patterns of fraud, waste, or abuse.
• Identify suspicious patterns such as upcoding, duplicate claims, and EVV inconsistencies.
• Differentiate between fraud, waste, and abuse and recommend actions.
• Translate findings into product and engineering requirements and dashboards.
• Present findings to state Medicaid agencies, MCOs, and internal stakeholders.

Skills

Fraud detection

Medicaid knowledge

Analytical thinking

Communication skills

AI tools familiarity

Data querying

Collaboration with product/engineers

Education

Bachelor’s degree in healthcare or related field

Tools

Python

R

BI tools

Job description

HHAeXchange is seeking a Sr Program Integrity Analyst to join the growing Program Integrity function. You will identify fraud, waste, and abuse patterns in Medicaid HCBS data and translate findings into scalable detection capabilities embedded in the platform.

Work across product, engineering, and client teams, validate detection tools, and present insights to state Medicaid agencies and MCOs. Remote role for EST/CST time zones within the US.