Fraud Audit & Investigations Specialist

Public Partnerships | PPL

. Support the FWA Analyst in standard and moderate-complexity fraud, waste, and abuse investigations .

Posted 10/14/2026full-timeRemote • United StatesJuniorMid-Level💰 $63,000 - $83,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in fraud investigations, compliance auditing, and regulatory documentation processes, with strong organizational skills to manage multiple cases and ensure accurate reporting. Proficient in collaborating with cross-functional teams and handling sensitive information with discretion and professionalism.

Highest-signal resume keywords

Fraud InvestigationsRegulatory RFI PreparationCompliance AuditingConsumer-Directed Care ProgramsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud InvestigationsRegulatory RFI PreparationCompliance AuditingDocumentation AssemblyCase File OrganizationConflict Report AnalysisQuality ControlData AnalysisReport GenerationProgram Integrity

Soft Skills

Clear Written CommunicationSound JudgmentDiscretionEmpathyProfessionalism

Industry Keywords

LHCSAMCOHealth Plan ComplianceMedicaidEVV ComplianceCDPAPLegal ComplianceRisk & AssuranceExternal AuditsCase Management

About the role

Key responsibilities & impact

Support the FWA Analyst in standard and moderate-complexity fraud, waste, and abuse investigations
Conduct outbound calls and case-related interviews with providers, consumers, caregivers, agencies, health plans, and other involved parties
Review conduct against program requirements, including CDPAP attestations, relationship restrictions, and EVV compliance
Coordinate with analytics, compliance, legal, and account management teams to gather and validate information
Recognize and escalate complex, high-risk, or legally sensitive matters
Assemble and organize case files, referral packages, and supporting documentation
Identify documentation gaps before quality control or external submission
Analyze conflict reports to identify scheduling overlaps and resolve discrepancies
Run and distribute daily and recurring reports
Assemble documentation for regulatory Requests for Information from MFCUs, OMIG, health plans, and other regulators or auditors
Maintain RFI tracking entries, status updates, and deadlines
Coordinate with Legal, Compliance, Risk & Assurance, and Operations on case and RFI documentation
Support external audits and assessment requests
Develop working knowledge of LHCSA operations, MCO/health plan compliance, SIU functions, and state regulator expectations
Support shared investigations and referral processes with MCO/health plan SIU and compliance counterparts
Provide frontline case-handling input when investigative and audit processes are designed or refined

Requirements

What you’ll need

Bachelor's degree preferred; substantial professional experience may be considered in lieu of a formal degree
2–3 years of combined experience across LHCSA, MCO/health plan, and/or state regulatory Medicaid roles
Prior experience in fraud investigations, program integrity, or compliance auditing preferred
Experience preparing or responding to regulatory RFIs, audits, or CAP documentation preferred
Experience with consumer-directed care programs such as CDPAP strongly preferred
Strong organizational and documentation skills
Ability to independently assemble accurate, well-organized case files
Ability to support multiple investigations or tasks simultaneously under general direction
Ability to escalate appropriately when complexity exceeds the role's scope
Clear written communication skills
Sound judgment and discretion when handling sensitive or confidential information
Comfort conducting outbound phone conversations about sensitive or confidential matters
Ability to deliver difficult information with professionalism and empathy
Comfort partnering with Analysts, the Senior Manager, and cross-functional stakeholders including compliance, legal, and operations

Benefits

Comp & perks

Remote work arrangement
Occasional business travel
Equal opportunity and inclusive workplace