Public Partnerships

Public Partnerships

Fraud Audit & Investigations Analyst

US Remote · Senior

Sponsorship not specified$78k-$99kDetected 14 days ago
AuditingCommunicationInternal Audit

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odds of building a lasting career here

50Sponsors, lottery-bound
Cap-exempt (no lottery)0
Sponsors this role90
Entry-level history0
PERM / green-card track0
Lottery odds (Level II)66
Fits your clock70

Sponsors, but it's cap-subject — you still face the weighted lottery (~30% per draw at Level II). Good if you win; have a cap-exempt backup on your list.

Lottery odds assume a STEM candidate.

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Employer immigration record

from this employer's Department of Labor filings

Green-card filing pattern in this occupation

Context, not a finding about this posting: of this employer's 7 green-card filings in this occupation, 100% were for a worker who already held the job.

Green-card follow-through: 67%

Of 6 labor certifications old enough to have been used, 2 expired without the employer filing the next step. Median time from filing to decision: 506 days.100% of their filings were for a worker who already held the job.Only certifications past the 180-day window are counted — recent ones cannot have expired yet.

Files H-1B transfers

1 transfer filing in the last year, covering 1 worker. Median labor-condition decision: 7 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

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About the role

  • The Program Integrity Fraud Audit & Investigations Analyst conducts fraud, waste, and abuse (FWA) investigations and serves as the team's lead for quality control and regulatory deliverable readiness.
  • This role investigates suspected FWA, audits and quality-checks case files and referral packages for completeness and regulatory sufficiency and owns the preparation and packaging of materials in response to Requests for Information (RFIs) from regulators, health plans, and law enforcement.
  • With a broad view of the Medicaid ecosystem, spanning LHCSA/provider agency operations, MCO/health plan processes, and regulator expectations, this person ensures investigations and audit deliverables meet the standards of OMIG, MFCUs, health plan partners, and other oversight bodies.

Responsibilities

  • Interview witnesses, gather and preserve evidence, and document findings in accordance with investigative standards and chain-of-custody practices
  • Partner with the analytics function to validate and further develop data-driven leads into case-ready findings
  • Perform quality control review of case files, referrals, and investigative documentation for completeness, accuracy, and regulatory sufficiency
  • Support internal audit-readiness reviews of the Program Integrity function
  • Ensure RFI responses are complete, accurate, well-organized, and appropriately documented; track deliverables and timelines to support timely submission and resolution.
  • Maintain a tracking log of all open and closed RFIs, including status, owners, and deadlines
  • Support preparation for external audits and assessment requests in partnership with the Risk and Assurance team
  • Support the Senior Director in maintaining relationships with regulators, MFCUs, and law enforcement partners

Requirements

  • Substantial professional experience in a related field may be considered in lieu of formal degree.
  • Prior experience in fraud investigations, program integrity, or compliance auditing required
  • Coordinate cross-functionally (Legal, Compliance, Risk & Assurance, Operations) to gather required documentation and data
  • Bachelor's degree preferred; substantial professional experience may be considered in lieu of a formal degree.

Nice to have

  • Bachelor's degree preferred
  • substantial professional experience may be considered in lieu of a formal degree.
  • Experience preparing or responding to regulatory RFIs, audits, or CAP documentation preferred
  • Experience with consumer-directed care programs (e.g., CDPAP) strongly preferred
  • Certification: CFE, AHFI, or CCEP preferred but not required.
  • experience across more than one of these perspectives is a strong plus

Skills

  • Demonstrated experience investigating and/or auditing fraud, waste, and abuse in a Medicaid or healthcare setting
  • Working knowledge of Medicaid program requirements, including consumer-directed care programs (e.g., CDPAP)
  • Excellent organizational and documentation skills; comfortable assembling audit-ready, regulator-facing materials
  • Strong written communication skills; able to produce clear, defensible, and professional case and audit documentation
  • Sound judgment and discretion when handling sensitive or confidential information
  • Comfortable partnering across compliance, legal, operations, and external stakeholders
  • Actual compensation will be determined based on a variety of factors, including skills, experience, and geographic location.
  • It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified

Compensation

  • $77,500 - $99,000
  • This role is eligible for a base salary within the posted range.
  • Actual compensation will be determined based on a variety of factors, including skills, experience, and geographic location.
  • Compensation may vary for positions based in high cost-of-labor markets.
  • At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.

Benefits

  • Conduct and/or support investigations into suspected fraud, waste, abuse, neglect, and exploitation referred from analytics, hotline reports, or health plan/regulator referrals
  • Serve as the lead for compiling, organizing, and quality-checking response packages for Requests for Information from MFCUs, OMIG, health plans, and other regulators or auditors
  • Serve as a subject matter expert with working knowledge of LHCSA agency operations, MCO/health plan compliance and SIU functions, and state regulator expectations
  • Partner with MCO/health plan SIU and compliance counterparts on shared investigations and referral processes
  • Provide the frontline and health plan perspective when designing or refining investigative and audit processes

Company info

  • We are appointed by states and managed healthcare organizations to better serve more of their residents and members requiring long-term care and ensure the efficient use of taxpayer funded services.
  • Our culture attracts and rewards people who are results-oriented and strive to exceed customer expectations.

Equal opportunity

  • PPL is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion.

Visa & Work Authorization

  • disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any
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This listing is sourced directly from Public Partnerships's careers page and normalized into a canonical job model.