Fraud Investigations Analyst

Job Summary

Conducting fraud, waste, and abuse investigations, the full-time remote Fraud Investigations Analyst will lead quality control efforts, manage regulatory deliverables, and ensure compliance with Medicaid standards while preparing documentation for regulatory inquiries.

Key Responsibilities

• Conduct investigations into suspected fraud, waste, and abuse, including interviewing witnesses and documenting findings
• Perform quality control reviews of case files and ensure adherence to regulatory requirements and internal protocols
• Compile and organize response packages for Requests for Information from regulators and maintain tracking logs for deliverables

Required Qualifications

• Bachelor's degree preferred; substantial professional experience may be considered in lieu of a formal degree
• 5-7 years of experience in LHCSA, MCO/health plan, and/or state regulatory Medicaid roles
• Prior experience in fraud investigations, program integrity, or compliance auditing required
• Experience preparing or responding to regulatory RFIs, audits, or corrective action plan documentation preferred
• Certification such as CFE, AHFI, or CCEP preferred