Conducting investigations/audits, visiting providers, identifying overpayments, initiating payment restrictions, writing summary reports, and making referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes.
Working collaboratively with other MPI operational units, and leading and/or participating in special projects or project initiatives.
Utilizing open-source and proprietary resources to conduct investigations and related administrative actions, as well as monitoring and tracking the associated case status.
Assisting in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data.

Requirements

Two years of professional or nonprofessional experience in a regulatory or health service setting.
An associate’s degree from an accredited college or university can substitute on a year for year basis in a related field such as health law, health science, health services administration, business administration, public administration, sociology, criminology, criminal justice, or a substantially similar discipline.
Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project Management Professional.
Preference will be given to candidates with professional experience in business, or information analysis.

Benefits

Health insurance (i.e., individual and family coverage) to eligible employees
Life insurance; $25,000 policy is free plus option to purchase additional life insurance
Dental, vision and supplemental insurance
State of Florida retirement options, including employer contributions
Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida
Ability to earn up to 104 hours of sick leave annually
Nine paid holidays and 1 personal holiday each year
Opportunities for career advancement
Tuition waivers (accepted by major Florida Colleges/universities)
Student loan forgiveness opportunities (eligibility required)
Training opportunities
Flexible Spending Accounts
Shared Savings Program for select medical services
Lower copays for prescription drugs
Health and Wellness discounts

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

investigationsauditsdata analysisreport writingcase monitoringpayment restrictionsfraud detectionoverpayment identificationadministrative actionsproject management

Soft Skills

collaborationleadershipcommunicationresearchproblem-solvingorganizational skillsanalytical thinkingattention to detailinitiativeinterpersonal skills

Certifications

Certified Fraud ExaminerAccredited Healthcare Fraud InvestigatorCertified Financial Crimes InvestigatorCertified Insurance Fraud InvestigatorCertified Compliance and Ethics ProfessionalProject Management Professional