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Medicaid Program Integrity Jobs in Virginia (NOW HIRING)

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Medicaid Program Integrity information

What is the difference between Medicaid Program Integrity vs Medicaid Claims Examiner?

AspectMedicaid Program IntegrityMedicaid Claims Examiner
Primary FocusDetecting and preventing fraud, waste, and abuse in Medicaid programsReviewing and processing Medicaid claims for accuracy and compliance
Required CredentialsTypically healthcare or compliance certifications, knowledge of Medicaid policiesHealthcare or claims processing certifications, attention to detail
Work EnvironmentRegulatory agencies, government offices, compliance departmentsInsurance companies, healthcare providers, government Medicaid offices

Medicaid Program Integrity professionals focus on safeguarding Medicaid funds by identifying fraudulent activities, while Medicaid Claims Examiners primarily verify claims for accuracy and proper coding. Both roles require healthcare knowledge and certifications but differ in their core responsibilities and work settings.

What are popular job titles related to Medicaid Program Integrity jobs in Virginia? For Medicaid Program Integrity jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Medicaid Program Integrity jobs in Virginia look for? The top searched job categories for Medicaid Program Integrity jobs in Virginia are:
What cities in Virginia are hiring for Medicaid Program Integrity jobs? Cities in Virginia with the most Medicaid Program Integrity job openings:
Medicaid Program Integrity jobs near you
Infographic showing various Medicaid Program Integrity job openings in Virginia as of July 2026, with employment types broken down into 81% Full Time, 9% Part Time, and 10% Contract. Highlights an 90% In-person, and 10% Remote job distribution.

Benefits Program Specialist III - CQI Records Reviewer

Abacus Solution Group

Virginia Beach, VA

Full-time

Posted yesterday

Job description

Benefit Program Specialist III

Location: Virginia Beach

About the Role

We are seeking a highly skilled and detail-oriented Benefit Program Specialist III to support quality assurance, compliance, and program improvement efforts across TANF, SNAP, and/or Medicaid programs. This role is ideal for someone with deep eligibility experience who enjoys problem-solving, coaching others, and ensuring program integrity.

Please: only apply if you have SNAP and state system knowledge.

Key Responsibilities

Quality Assurance & Case Review

• Conduct on-site case reviews for Benefit Programs staff to measure, evaluate, and ensure quality performance and compliance with state and federal regulations.

• Review cases for accuracy, identify significant errors or trends, and determine whether issues stem from the section, unit, or individual staff.

• Document findings and compare results with established program guidelines.

• Conduct entrance and exit conferences for scheduled case reviews.

Training, Support & Technical Assistance

• Provide consultation and technical assistance on program policies, regulations, and procedures.

• Deliver refresher training based on case review findings.

• Assist with planning and administering policy tests related to Benefit Program areas.

• Support recruitment and selection of new Benefit Program Specialist team members.

Program Evaluation & Audit Support

• Serve as a team member for SNAP Management Evaluation (ME) Reviews, Regional Reviews, and Audits.

• Conduct research and investigate problematic areas to prepare for state and regional reviews.

• Collaborate with external partners to address error-prone program areas and support corrective action plans.

Policy & System Expertise

• Serve as a resource on eligibility requirements, policy interpretation, and VaCMS troubleshooting.

• Resolve discrepancies internally before escalating to regional or state-level staff.

• Monitor program operations and staff performance to ensure quality standards are met.

• Act as a lead worker, providing guidance and support to team members.

Minimum Qualifications

• A combination of education beyond high school and/or experience equivalent to seven (7) years in roles requiring knowledge of eligibility programs (e.g., Eligibility Worker).

• Equivalent combinations of training and experience that demonstrate the required knowledge, skills, and abilities will be considered.

Preferred Skills

• Strong understanding of TANF, SNAP, and Medicaid eligibility policies.

• Experience conducting case reviews or audits.

Abacus Corporation is a family-owned leader in workforce and talent solutions with over 80 years of experience. We specialize in connecting skilled professionals with direct hire opportunities across industries like industrial, security, healthcare, finance and professional services.

Known for our supportive culture and long-standing client partnerships, Abacus offers more than just a job—we provide a path to lasting career growth with trusted employers nationwide.

• Excellent analytical, communication, and problem-solving abilities.

• Ability to work collaboratively across teams and with external partners.

• Proficiency with VaCMS or similar eligibility systems

Apply