Fraud Investigations Analyst

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