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Medicaid Fraud Analyst Jobs (NOW HIRING)

Georgia

Investigator - Medicaid Fraud

Atlanta, GA

$50/hr

Investigator - Medicaid Fraud Job Requisition ID: JR0000000386 Number of Openings: 1 Shift: Day ... Assists criminal justice personnel, including, but not limited to, Analysts, Auditors, and ...

CACI International, Inc.

Fraud Analyst

Baltimore, MD · On-site

Job Title: Fraud Analyst Job Category: Finance and Accounting Time Type: Part time Minimum ... Formulate data runs or inquiries from large Medicare and Medicaid databases to elicit particular ...

ITC Federal, Inc.

Fraud Analyst

Fraud Analyst AGENCY SUPPORTED: U.S. Department of Justice (DOJ) - MEGA 6 Automated Litigation ... Familiarity with specific subject matter helpful - Medicare and Medicaid claims, student loan ...

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Medicaid Fraud Analyst information

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$130.5K

How much do medicaid fraud analyst jobs pay per year?

As of Jul 15, 2026, the average yearly pay for medicaid fraud analyst in the United States is $56,776.00, according to ZipRecruiter salary data. Most workers in this role earn between $45,000.00 and $55,000.00 per year, depending on experience, location, and employer.

What are Medicaid Fraud Analysts?

Medicaid Fraud Analysts are professionals responsible for investigating, detecting, and preventing fraudulent activities within the Medicaid program. They analyze data, conduct research, and collaborate with law enforcement and other agencies to identify improper billing, false claims, or abuse of Medicaid funds. Their work helps ensure that Medicaid resources are used appropriately and that fraudsters are held accountable. Medicaid Fraud Analysts play a vital role in protecting taxpayer dollars and maintaining the integrity of the healthcare system.

Is fraud analysis a good career?

A Medicaid Fraud Analyst role involves reviewing claims and data to detect and prevent fraudulent activities, requiring analytical skills and attention to detail. It can be a stable career with opportunities for advancement and often involves working with specialized software and compliance standards.

How to become a healthcare fraud investigator?

To become a healthcare fraud investigator, typically one needs a bachelor's degree in criminal justice, healthcare administration, or a related field. Relevant experience in healthcare, law enforcement, or auditing, along with knowledge of healthcare laws and regulations, is important. Certifications such as Certified Fraud Examiner (CFE) can enhance job prospects in this field.

How do I become a fraud analyst?

To become a Medicaid Fraud Analyst, candidates typically need a bachelor's degree in fields such as criminal justice, healthcare administration, or a related area. Relevant skills include data analysis, attention to detail, and knowledge of healthcare laws and regulations; certifications like Certified Fraud Examiner (CFE) can enhance prospects. Experience in healthcare or fraud investigation is often preferred by employers.

What is the difference between Medicaid Fraud Analyst vs Medicaid Compliance Specialist?

AspectMedicaid Fraud AnalystMedicaid Compliance Specialist
Required CredentialsTypically a bachelor’s degree in criminal justice, healthcare administration, or related field; certifications like CFE (Certified Fraud Examiner) are commonSimilar credentials; often holds certifications like CHC (Certified in Healthcare Compliance) or CCEP (Certified Compliance & Ethics Professional)
Work EnvironmentGovernment agencies, healthcare organizations, or insurance companies focusing on fraud detectionHealthcare providers, insurance companies, or regulatory agencies ensuring compliance with Medicaid policies
Employer & Industry UsageUsed in government and private sectors to identify and investigate Medicaid fraudUsed across healthcare organizations to ensure adherence to Medicaid regulations and policies

Both roles require knowledge of Medicaid policies and investigative skills. While Medicaid Fraud Analysts focus on detecting and investigating fraud, Medicaid Compliance Specialists ensure organizations follow Medicaid rules. Both positions are vital in maintaining program integrity and often collaborate within healthcare compliance teams.

What are some common challenges faced by Medicaid Fraud Analysts when investigating potential fraud cases?

Medicaid Fraud Analysts often encounter challenges such as sifting through large volumes of complex data to identify suspicious patterns, staying updated on evolving fraud tactics, and ensuring compliance with legal and regulatory standards. Collaborating with healthcare providers, law enforcement, and legal teams requires clear communication and attention to detail. Additionally, analysts must balance thorough investigations with the need for timely resolution to prevent ongoing fraudulent activity and minimize financial losses for the Medicaid program.

What does a Medicaid fraud investigator do?

A Medicaid fraud investigator examines claims and billing records to detect and prevent fraudulent activities related to Medicaid services. They analyze data, interview witnesses, and collaborate with law enforcement to ensure compliance and recover funds. Strong analytical skills and knowledge of healthcare regulations are essential for this role.

What are the key skills and qualifications needed to thrive as a Medicaid Fraud Analyst, and why are they important?

To thrive as a Medicaid Fraud Analyst, you need strong analytical skills, attention to detail, and knowledge of healthcare regulations, typically supported by a bachelor’s degree in criminal justice, healthcare administration, or a related field. Familiarity with data analysis tools, case management systems, and fraud detection software is essential. Excellent communication, critical thinking, and investigative skills help you collaborate with law enforcement and present findings effectively. These abilities are vital for accurately identifying, investigating, and preventing fraudulent activities that can harm public health programs.
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What states have the most Medicaid Fraud Analyst jobs? States with the most job openings for Medicaid Fraud Analyst jobs include:
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Medicaid Fraud Analyst jobs near you
MEDICAID FRAUD ANALYST II - 41001293 1

MEDICAID FRAUD ANALYST II - 41001293 1

MyFlorida

Orlando, FL

$57K/yr

Other

Medical, Dental, Vision, Life, Retirement

Posted 2 days ago

New

State Of Florida rating

6.7

Company rating: 6.7 out of 10

Based on 185 frontline employees who took The Breakroom Quiz

45th of 50 rated states

Job description

Requisition No: 879395 

Agency: Office of the Attorney General

Working Title: MEDICAID FRAUD ANALYST II - 41001293 1

 Pay Plan: Career Service

Position Number: 41001293 

Salary:  $57,783.18 annually 

Posting Closing Date: 08/04/2026 

Total Compensation Estimator Tool

Our Organization and Mission: The Office represents the State of Florida in state and federal civil and criminal courts, from trial courts to the Supreme Court of the United States. 

Position Summary: This Medicaid Fraud Analyst II position is in the Office of the Attorney General within Medicaid Fraud Control Unit in Orlando and Tallahassee, Florida. If the selected candidate choose the Tallahassee location, candidate will requested for the position to be moved from Orlando to Tallahassee at that time. 

Pay: $57,783.18 Annually

Qualifications: 

Five (5) years of experience in research, investigations, investigative analysis or statistics; or
A Bachelor degree from an accredited college or university and one (1) year of professional experience in research, investigations, investigative analysis or statistics.

Preference will be given to candidates who have experience compiling and analyzing investigative information, or experience in the use of spreadsheets and relational database applications.

**SKILLS VERIFICATION TEST ** All applicants who meet the screening criteria/minimum job requirements will be required to take a timed Skills Verification Test.  Applicants must receive a score of at least 70% to move to the interview phase.

The Work You Will Do: The responsibilities of this position include, but are not limited to the following: 

An employee in this position provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. An employee in this position also performs work conducting detailed research and analysis of investigative information relating to alleged violations of applicable laws pertaining to health care fraud, in the administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. An employee in this position may also perform as lead analyst on specialized complex civil enforcement investigations and litigation matters and analytical projects.

Additional roles and duties to design and write new EDW ad hoc reports and queries, serve as a MFCU analyst providing EDW support throughout the MFCU, and serve as an instructor on the new EDW to the various MFCU regional offices, in support of Operations & Management Consultant I and Operations & Management Consultant II.

35% Create customized downloads from on-line Medicaid claims data warehouse as requested by investigators, attorneys, and multistate investigative and litigation teams.

25% Prepare reports/schedules/charts pertaining to all aspects of the analysis and research for use in criminal prosecution, civil actions and administrative referrals.

20%  Assists and supports Medicaid fraud investigators and attorneys in the compilation and analysis of investigative information and the development of damages models for use in Florida-specific and multistate health care fraud investigations and litigation. Obtains and analyzes large amounts of data to: interpret and summarize health care fraud activity, calculate damages sustained to the Florida Medicaid program, determine significance, completeness and usefulness of data, recognize and identify patterns and trends, and brief investigators and attorneys.

10% Extract information from investigative databases. Compile, analyze and disseminate intelligence information retrieved from various computer databases/systems. Perform various duties related to computers.

5% Assist in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.


5% Other duties as assigned.

Candidate Profile (application) must be completed in its entirety.

  • Include supervisor names and phone numbers for all periods of employment.
  • Account for and explain any gaps in employment so that the hiring process is not delayed.
  • Experience, education, training, knowledge, skills and/or abilities as well as responses to pre-qualifying questions must be verifiable to meet the minimum qualifications. 
  • It is unacceptable to use the statement "See Resume" in place of entering work history.
  • If you experience problems applying online, please call the People First Service Center at (877) 562-7287.  

The Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including:

  • Annual and Sick Leave benefits.
  • Nine paid holidays and one Personal Holiday each year.
  • State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options.
  • Retirement plan options, including employer contributions (For more information, please click www.myfrs.com).
  • Flexible Spending Accounts
  • Tuition waivers.
  • And more! For a more complete list of benefits, visit www.mybenefits.myflorida.com.

IMPORTANT NOTICE: To be considered for the position, all applicants must:

Submit a complete and accurate application profile necessary for qualifying such as dates of service, reason for leaving, etc. In addition, all applicants must ensure all employment and/or detailed information about work experience is listed on the application (including military service, self-employment, job-related volunteer work, internships, etc.) and that gaps in employment are explained. 

 

NOTE: Any required experience and/or preferences listed in the advertisement must be verified at the time of application.

  • Ensure that applicant responses to qualifying questions are verifiable by skills and/or experience stated on the employment application and/or resume. Applicants who do not respond to the qualifying questions will not be considered for this position.
  • The elements of the selection process may include a skill assessment exercise. 
  • Current and future vacancies may be filled from this advertisement for a period of up to six months. Following the six-month period, a new application must be submitted to an open advertisement to be considered for that vacancy.
  • OAG employees are paid biweekly. All state employees are required to participate in the direct deposit program pursuant to s. 110.113, F.S.

CRIMINAL BACKGROUND CHECKS/ DRUG FREE WORKPLACE: All OAG positions are "sensitive or special trust" and require favorable results on a background investigation including fingerprinting, pursuant to s. 110.1127(2)(a), F.S. The State of Florida supports a Drug-Free Workplace, all employees are subject to reasonable suspicion or other drug testing in accordance with section 112.0455, F.S., Drug-Free Workplace Act. We hire only U.S. citizens and those lawfully authorized to work in the U.S.

E-VERIFY STATEMENT: The Office of the Attorney General participates in the U.S. government's employment eligibility verification program (e-verify). E-verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of the employment eligibility verification form (i-9).

PERSONS WITH DISABILITY/ADA STATEMENT: The OAG supports the employment of individuals with disabilities and encourages them to seek employment within our agency. If you need an accommodation because of a disability, as defined by the Americans with Disabilities Act, in order to participate in the application process, please notify the people first service center at 877-562-7287. If you need an accommodation during the selection process, please notify the hiring authority in advance to allow sufficient time to provide an accommodation.

REMINDERS: Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Service System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from SSS. For more information, please visit the SSS website at: https: //www.sss.gov. If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. If you return to FRS employment before satisfying the required waiting period, your retirement may be voided, and you may have to repay all benefits you have received, including any Deferred Retirement Option Program (DROP) payout.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS' PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans' Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement. 

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