Fraud Audit and Investigations Analyst

About the role

Investigate suspected fraud, waste and abuse in long term home care programs, and lead quality control and regulatory response work for the program integrity team.

What you will do

• Carry out or support investigations of suspected fraud, waste, abuse, neglect and exploitation from analytics, hotlines or referrals
• Interview witnesses, secure evidence and record findings following investigative and chain of custody standards
• Review provider, consumer and caregiver conduct against program rules, including attestations, relationship limits and EVV compliance
• Work with analytics staff to turn data driven leads into case ready findings
• Write case summaries and referral recommendations for senior leadership and outside agencies
• Quality check case files, referrals and documentation, and assemble response packages for regulator requests

What they look for

• Background in fraud, waste and abuse investigations within Medicaid or managed care settings
• Knowledge of home care provider agency operations, health plan processes and regulator expectations
• Experience with investigative documentation standards and chain of custody practices
• Skill in auditing files for completeness, accuracy and regulatory sufficiency
• Ability to analyze processes, flag risks and propose improvements
• Strong written communication for case summaries and regulatory deliverables