Remote Senior Program Integrity Analyst

Socket.dev; United States; Remote; USD 155,000 - 165,000; Full time

Benefits offered by this job

Health plans

Paid time off

401K retirement with company match

Job summary

HHAeXchange in the United States is seeking a Sr Program Integrity Analyst to safeguard Medicaid home and community-based care data. You will identify fraud patterns, translate findings into actionable requirements, and work with product and engineering to embed detection logic in the platform.

This remote role requires at least 5 years in healthcare fraud detection, strong analytical and communication skills, and the ability to explain complex results to non-technical stakeholders.

Qualifications

• Bachelor’s degree and a minimum of 5 years experience in healthcare fraud detection, program integrity, payment integrity, SIU investigation, or a closely related field.
• Knowledge of how Medicaid programs operate, including enrollment, documentation, claims, and reimbursement.
• Ability to recognize FWA patterns in healthcare data and distinguish fraud, waste, and abuse.

Responsibilities

• Fraud Waste and Abuse Analysis and Fraud Pattern Identification in Medicaid home and community-based care data.
• Translate findings into clear business requirements for product and engineering teams.
• Present fraud findings to state Medicaid agencies, managed care organizations, and internal stakeholders.
• Document methodologies and support regulatory audits and reporting obligations.
• Collaborate on detection dashboards, alerts, and investigation workflows.

Skills

Healthcare fraud detection

Program integrity

Data analysis

Communication

Education

Bachelor's degree in a healthcare-related field

Tools

Python

R

Data visualization

Job description

HHAeXchange in the United States is seeking a Sr Program Integrity Analyst to safeguard Medicaid home and community-based care data. You will identify fraud patterns, translate findings into actionable requirements, and work with product and engineering to embed detection logic in the platform.

This remote role requires at least 5 years in healthcare fraud detection, strong analytical and communication skills, and the ability to explain complex results to non-technical stakeholders.