Jobs in the United States

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Added 10 mins ago
Manager, Treasury
THE CHARLES STARK DRAPER LABORATORY INC
CLEARFIELD, UT
Added 33 mins ago
Catastrophe Business Analyst
MS ACSC Management Services Inc
Costa Mesa, CA
The Business Analyst (BA) works as a member of the Catastrophe (CAT) Planning & Logistics Team, supporting efforts to ensure organizational readiness and effective response to catastrophe…
Added 5 hours ago
BS
Senior Advisor, Vaccine & Clinical Case Management
BME Strategies
Remote, United States
- $91,520 to $151,840 USD / year
Bill for clinical services by verifying insurance, generating claims and tracking reimbursement from MassHealth, Medicare and commercial payers.
Added 5 hours ago
UO
Data Analyst, Senior Professional Research Assistant Level 3
University of Colorado Denver
Aurora, CO
- $67,209 to $105,729 USD / year
Job Title: Data Analyst, Senior Professional Research Assistant Level 3
Added 8 hours ago
CO
PROGRAM SPECIALIST - RISK ANALYST I
City of Stockton
Stockton, CA
- $38.48 USD / hour
Under general direction, provides administrative, statistical, claims, and confidential staff analysis for the Risk Services division of the Human Resources Department; assists in the…
Added 11 hours ago
AP
Commercial Data Product Owner - Job ID: 2080
Ascendis Pharma
Remote, United States
- $180,000 to $190,000 USD / year
…Oncology portfolios. We also collaborate with partners on the development of TransCon-based products in other therapeutic areas and…
Added 14 hours ago
Sales Support Administrator
Mustang Cat
Houston, TX
Submit loaner goodwill claims and ensure payment has been received
Added 17 hours ago
[Mid Level] Korean Bilingual Business Analyst - Finance, Business Operations & Supply Chain Analytics (261101-1)
JND
Dallas, TX
…including data analytics, financial analysis, supply chain, program management, and strategic planning. We also have opportunities in software development, QA/testing, network engineering,…
Added 18 hours ago
Business Analyst, Consultant - Quality Performance
BSC
El Dorado Hills, CA · CA · Long Beach, CA · Lodi, CA · Rancho Cordova, CA · Redding, CA · San Diego, CA · Woodland Hills, CA
…prescription medications used by Blue Shield members. The Business Analyst, Consultant, Rx Quality Performance Management will report to the Senior Manager, Rx Member Experience & Quality…
Added 19 hours ago
T&D Operations Analyst - Oahu
hawaiianel
Honolulu
…controlling support for all projects. Configures and manages project/program information and management systems including development of project/program plans including but not limited to…
Added 19 hours ago
Quality Improvement Analyst II
CareOregon, Inc.
Remote, United States
Develop dashboards and visual assessments of health care quality metric performance and key performance indicators using claims, administrative, and/or program data.
Added 19 hours ago
Employee Benefits Analyst
Portland General Electric Company
Portland, OR
…disability, return-to-work matters, and workers' compensation claims. Coordinate with employees, managers, HR partners, vendors, and other internal partners; monitor case status; support…
Added 1 day ago
Senior Analyst, AI Automation and Development
CVS Health
Hartford, CT
As a Senior Analyst on the Program Modernization, Automation, and Development team, you will help turn growing business and compliance demands into efficient, repeatable, and scalable…
Added 1 day ago
LD
Senior Production Data Analyst
Leonardo DRS, Inc.
Germantown, MD
- $83,552 to $108,618 USD / year
DRS RADA Technologies is hiring a Senior Production Data Analyst to join its rapidly growing manufacturing team in Germantown, MD.
Added 1 day ago
BC
Reimbursement Analyst
Blue Cross Blue Shield of Kansas
Topeka, KS
- $28.6 USD / hour
Added 1 day ago
Renewal and Reporting Analyst
CVS Health
Remote, United States
…online viewing and processing, related to customer service, claims, enrollment, billing, and reporting, in support of internal and external…
Added 1 day ago
Vendor Contract Auditor
City of New York
New York City, NY
Only those on the Staff Analyst list, Exam 3116 or permanent incumbents are eligible to apply.
Added 1 day ago
T&D Operations Analyst - Oahu
Hawaiian Electric
Honolulu, HI
…controlling support for all projects. Configures and manages project/program information and management systems including development of project/program plans including but not limited to…
Added 1 day ago
Pharmacy Business Support Specialist
CHS Pharmacy Services, Inc.
Winston Salem, NC
Reconciles pharmacy claims to third party and interdepartmental payments. Tracks and reports payments, receivables, and bad debt. Reviews EOB’s and reconciles bank deposits.
Added 1 day ago
Renewal and Reporting Analyst
CVS Health
Remote, United States
…online viewing and processing, related to customer service, claims, enrollment, billing, and reporting, in support of internal and external…
Added 1 day ago
UG
Coding Quality Analyst
UnitedHealth Group
Plymouth, MN
- $24 to $43 USD / hour
…inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global…
Added 1 day ago
UG
Coding Quality Analyst
UnitedHealth Group
Plymouth, MN
- $24 to $43 USD / hour
…inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global…
Added 1 day ago
W
Senior Analyst, Actuarial Consulting (P&C)
WTW
Philadelphia, PA
- $80,000 to $120,000 USD / year
…Estimate future claim payments for past policies using loss development and claims data; apply machine-led reserving approaches and AI-enhanced actuarial methodologies; support financial…
Added 1 day ago
ER
Actuarial Analyst, Global Reserving
EVEREST REINSURANCE COMPANY
Warren, NJ
- $90,000 to $120,000 USD / year
The Senior Actuarial Analyst will support the Global Reserving team in evaluating reserve adequacy across Everest's Insurance and Reinsurance portfolios. This role will contribute to…
Added 1 day ago
Data Analyst Claims
Mercury Insurance Services, LLC
United States
…interpreting complex data sets related to various operations of the Claims Department and provide data-driven analysis. The position is responsible for analyzing and interpreting data,…

CoventBridge Integrity Systems

Medicaid/Medicare Program Integrity Analyst II

Remote, United States

$70,000 to $77,000 USD / year

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Job details

Pay: $70,000 to $77,000 USD / year
Apply by: Oct 30, 2027
Posting language: English
Posted: Oct 30, 2026

Original job description

Overview

Medicaid/Medicare Program Integrity Analyst II - REMOTE

The Medicaid/Medicare Program Integrity Analyst II performs evaluation and development of leads, complaints, and/or investigations to verify allegations of potential fraud. Recommends and/or implements appropriate administrative actions.

In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity Systems' objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

This position will report directly to the Program Integrity Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.

Responsibilities/ Requirements

Responsibilities:

Perform evaluation and development of leads, complaints, and/or investigations to determine if further investigation and administrative actions are warranted
Conduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuse
Utilize basic data analysis techniques to detect aberrancies in Medicare and Medicaid claims data, and proactively seeks out and develops leads/investigations received from a variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)
Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and Medicaid policies and initiate appropriate action
Make potential fraud determinations by utilizing a variety of sources such as internal guidelines, Medicare and Medicaid provider manuals, Medicare and Medicaid regulations, and the Social Security Act
Compile and maintain documentation and information related to investigations, cases, and/or leads
Participate in onsite audits in conjunction with investigation development
Develop and prepare potential Fraud Alerts and program vulnerabilities for submission to CMS. Share information on current fraud investigations with other Medicare contractors and state Medicaid agencies, law enforcement, and other applicable stakeholders
Prepare and submit external correspondence and reports, including, but not limited to, overpayment letters, fraud case referrals, suspensions, rebuttals, Medicare/Medicaid findings reports, and administrative action recommendations
Submit suspension notifications to providers upon suspension approval
Prepare and submit ADR letters to providers associated with requests for medical record requests or suspension overpayment determinations
Serve as mentor/trainer to new Program Integrity staff
Perform other duties as assigned by PI Supervisor or PI Manager that contribute to task order goals and objectives

Requirements:

Excellent research and organization, prioritization, and time management skills
Excellent verbal and written communication skills
Ability to work independently with minimal supervision
Ability to multi-task in a fast-paced environment
Knowledge of statistics, data analysis techniques, and PC skills are preferred

Educational/Experience Qualifications:

High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
Candidates with Certified Fraud Examiner (CFE) Certifications will be given priority consideration
At least 1 year of experience in Program Integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions

Benefits

Medical, Dental, Vision plans
Life, LTD and STD paid by the employer
401(k) with company match up to 4%
Paid Time Off and company paid holidays
Tuition assistance after 1 year of service

The salary range for this role is $70,000 to $77,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)

About Us:

CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.

CoventBridge Integrity Systems is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.

CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

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