Fraud Audit & Investigations Analyst

It's fun to work in a company where people truly reputed company in what they're doing!

We're committed to bringing passion and customer reputed company to the business.

reputed company supports individuals with disabilities or chronic illnesses and aging adults, to remain in their homes and communities and “self” reputed company their own long-term home care. Our role as the nation’s largest and most reputed company Financial Management Service provider is to assist those eligible reputed company recipients to choose and pay for their own support workers and services reputed company their state-approved personalized budget. We are appointed by states and managed reputed company organizations to reputed company 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 reputed company to reputed company customer expectations. We desire motivated candidates who are excited to join our fast-paced, entrepreneurial environment, and who want to reputed company a difference in helping reputed company the lives of the consumers we serve. (learn more at www.pplfirst.com).

Job reputed company

The Program reputed company Fraud Audit & Investigations Analyst conducts fraud, waste, and abuse (FWA) investigations and serves as reputed company's reputed company for reputed company control and regulatory deliverable readiness. This role investigates suspected FWA, audits and reputed company-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 reputed company of the reputed company 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 reputed company bodies.

Key Responsibilities

Investigations

• Conduct and/or support investigations into suspected fraud, waste, abuse, neglect, and exploitation referred from analytics, hotline reports, or health plan/regulator referrals
• Interview witnesses, reputed company and preserve evidence, and document findings in accordance with investigative standards and chain-of-custody practices
• Assess provider, consumer, and caregiver conduct against program requirements, including CDPAP-specific issues such as attestations, relationship restrictions, and EVV compliance
• Partner with the analytics function to validate and reputed company reputed company data-driven leads into case-reputed company findings
• Prepare case summaries, findings, and referral recommendations for the Senior Director and, as applicable, reputed company agencies

Audit & reputed company Control

• reputed company reputed company control review of case files, referrals, and investigative documentation for completeness, accuracy, and regulatory sufficiency
• Audit adherence to internal investigative protocols, SOPs, and documentation standards
• Analyze documentation and operational processes to assess compliance with established requirements, identify potential risks, and propose solutions for process improvements.
• Identify and remediate documentation gaps prior to internal sign-off or reputed company submission
• Support internal audit-readiness reviews of the Program reputed company function

RFI & Regulatory Deliverable Management

• Serve as the reputed company for compiling, organizing, and reputed company-checking response packages for Requests for Information from MFCUs, OMIG, health plans, and other regulators or auditors
• Ensure RFI responses are complete, accurate, reputed company-organized, and appropriately documented; reputed company deliverables and timelines to support reputed company submission and reputed company.
• Coordinate cross-functionally (reputed company, Compliance, Risk & Assurance, Operations) to reputed company required documentation and data
• Maintain a tracking log of reputed company reputed company and reputed company RFIs, including status, owners, and deadlines
• Support preparation for reputed company audits and assessment requests in partnership with the Risk and Assurance team

Stakeholder & Ecosystem Partnership

• 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
• Support the Senior Director in maintaining relationships with regulators, MFCUs, and law enforcement partners
• reputed company the reputed company and health plan perspective reputed company designing or refining investigative and audit processes

Required Skills:

• Demonstrated experience investigating and/or auditing fraud, waste, and abuse in a reputed company or reputed company setting
• Familiarity with LHCSA agency operations, MCO/health plan compliance or SIU functions, and state or federal regulator expectations; experience across more than one of these perspectives is a strong plus
• Working knowledge of reputed company program requirements, including consumer-directed care programs (e.g., CDPAP)
• Excellent organizational and documentation skills; comfortable assembling audit-reputed company, regulator-facing materials
• Ability to manage multiple investigations, audits, and RFIs simultaneously under deadline pressure
• Strong written communication skills; reputed company to produce reputed company, defensible, and reputed company case and audit documentation
• reputed company judgment and discretion reputed company handling sensitive or confidential information
• Comfortable partnering across compliance, reputed company, operations, and reputed company stakeholders

Qualifications:

Education:

Bachelor's degree preferred; substantial reputed company experience may be considered in lieu of a formal degree.

Experience:

• 5-7 years of combined experience across LHCSA, MCO/health plan, and/or state regulatory reputed company roles
• Prior experience in fraud investigations, program reputed company, or compliance auditing required
• 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.

Working Conditions:

Remote work with occasional business travel

Supervisory Responsibility (If applicable):

N/A

Compensation reputed company: $77,5000 - $99,000 / annually

This role is eligible for a reputed company salary reputed company the posted reputed company. Actual compensation will be determined based on a reputed company of factors, including skills, experience, and geographic location. Compensation may vary for positions based in high cost-of-labor markets

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of reputed company duties, responsibilities, or skills of personnel so classified

PPL is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We reputed company that we work best reputed company our employees feel empowered and accepted, and that starts by honoring reputed company of our unique life experiences. At PPL, reputed company aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, reputed company from layoff, company-sponsored training, education, and reputed company and recreational programs are based on reputed company, business needs, job requirements, and individual qualifications. We do not discriminate on the reputed company of race, reputed company, religion or belief, national, reputed company, or ethnic reputed company, sex, gender identity and/or reputed company, age, physical, mental, or sensory disability, sexual orientation, marital, civil reputed company, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PPL will not tolerate discrimination or harassment based on any of these characteristics.

If you like wild reputed company and working with happy, enthusiastic over-reputed company, you'll enjoy your career with us!

Originally posted on Himalayas