Audit Investigator

Health Integrity, LLC, awholly owned subsidiary of Quality Health Strategies, is responsible for performing benefit integrity tasks for CMS related to multiple Medicare and Medicaid contracts by monitoring complaints and initiating fraud investigations for referral to the Office of Inspector General (OIG) as well as supporting cases with data, medical and pharmaceutical experience, audits, training and investigative expertise.

Health Integrity has been awarded contracts related to reviewing claims submitted by Medicaid providers to determine incorrect payments and identify overpayments, and has an immediate opening for an experienced Auditor Investigator.

This position supports the mission of Health Integrity to satisfy its contractual obligations with CMS as an Audit Medicaid Integrity Contractor (Audit MIC). The contract covers 24 states in the Midwest and Northeast, and frequent travel is required.

You will join a team that audits / reviews claims submitted by Medicaid providers across all service and provider types, to validate medical necessity of claims, examining payments to Medicaid providers and, where payments were not valid, establish overpayments and initiate action to recover incorrectly paid funds.

The position requires two years of experience in health care program integrity as a claims auditor or investigator, or a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions, preferably in a health care environment. A Bachelor's Degree and/or a certificate in a related field (e.g., Certified Fraud Investigator, Certified Professional Medical Auditor, etc.) is preferred.

The contract covers 24 jurisdictions (23 states and the District of Columbia) in the Midwestern, Southeastern and Mid-Atlantic United States, and frequent travel may be required. Use of personal or rental vehicle for regular travel to areas that may not be serviced by public transportation may be required.

We offer

Excellent company paid benefits

Interesting and challenging work

A stimulating work environment

The chance to join a team in making a positive difference

Affirming equal opportunity in principle and practice, Health Integrity is an equal opportunity employer, committed to developing a diverse workforce.

For more information about Health Integrity and to apply online, visit our website at: and click on the careers link.