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Program Integrity Director Jobs in Worcester, MA

LUK Inc.

Adventure Program Manager

Fitchburg, MA · On-site

$66K - $71K/yr

Facilitate the integrity of the family while ensuring the safety of all family members. The Program Manager is responsible to work with the Director and Coordinator to manage program service delivery ...

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All JobsProgram Integrity Director JobsProgram Integrity Director Jobs in Worcester, MA

Program Integrity Director information

See Worcester, MA salary details

$29.4K

$78K

$136.7K

How much do program integrity director jobs pay per year?

As of Jun 28, 2026, the average yearly pay for program integrity director in Worcester, MA is $78,025.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,900.00 and $92,300.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Program Integrity Director, and why are they important?

To thrive as a Program Integrity Director, you need expertise in compliance, risk management, regulatory analysis, and a relevant degree such as in business administration, public policy, or law. Familiarity with data analytics tools, case management systems, and certifications like Certified Fraud Examiner (CFE) or Certified Internal Auditor (CIA) are often important. Strong leadership, ethical judgment, and effective communication skills are crucial for building trust and guiding teams through complex investigations. These skills ensure the organization maintains regulatory compliance, prevents fraud, and promotes operational transparency.

What is the difference between Program Integrity Director vs Claims Manager?

AspectProgram Integrity DirectorClaims Manager
Required CredentialsBachelor's degree, certifications in healthcare compliance or auditingBachelor's degree, experience in claims processing or insurance
Work EnvironmentHealthcare or insurance organizations, compliance departmentsInsurance companies, healthcare payers, claims processing units
Employer & Industry UsageUsed in healthcare, government programs, insurance sectorsPrimarily in insurance companies and healthcare payers

The Program Integrity Director focuses on ensuring compliance, preventing fraud, and maintaining program integrity within healthcare or insurance organizations. In contrast, Claims Managers oversee the processing and adjudication of insurance claims. While both roles require knowledge of healthcare or insurance operations, the Program Integrity Director emphasizes compliance and fraud prevention, whereas the Claims Manager concentrates on claims processing efficiency and accuracy.

What are Program Integrity Directors?

Program Integrity Directors are responsible for overseeing and ensuring the compliance, effectiveness, and accountability of organizational programs, often within government agencies or large organizations. They develop and implement policies to prevent fraud, waste, and abuse, and they monitor program operations to ensure adherence to regulations and standards. Program Integrity Directors often lead teams, conduct audits, and collaborate with other departments to promote transparency and ethical practices. Their work is crucial for maintaining public trust and ensuring resources are used appropriately.

What are some typical challenges faced by a Program Integrity Director, and how can they be addressed?

Program Integrity Directors often face challenges such as navigating complex regulatory requirements, detecting and preventing fraud, and ensuring compliance across multiple departments or partners. Addressing these requires strong analytical skills, clear communication, and effective collaboration with legal, compliance, and operational teams. Staying updated on industry best practices and fostering a culture of transparency can also help mitigate risks and support program goals.
What job categories do people searching Program Integrity Director jobs in Worcester, MA look for? The top searched job categories for Program Integrity Director jobs in Worcester, MA are:
What cities near Worcester, MA are hiring for Program Integrity Director jobs? Cities near Worcester, MA with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Infographic showing various Program Integrity Director job openings in Worcester, MA as of June 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 100% In-person job distribution, with an average salary of $78,025 per year, or $37.5 per hour.
Medical Program Integrity Auditor

Medical Program Integrity Auditor

University of Massachusetts Medical School

Westborough, MA • On-site, Remote

$80K - $95K/yr

Full-time

Posted 27 days ago

Job description

Under the general direction of the Associate Director or designee, the Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in identifying, investigating, and preventing fraud, waste and abuse for Medicaid programs. A major function of this position is to conduct desk and onsite audits across various provider types to ensure compliance with federal and state regulations. The Auditor performs investigative activities to develop leads and detect aberrant billing practices, including data mining, claims analysis, and medical record assessment.

Onsite requirement 1-2 times per month, all other aspects of the job are remote.


Responsibilities:

  • Ensure compliance with federal and state regulations and healthcare FWA industry standards.
  • Perform independent data mining and data analysis utilizing claims data to detect patterns and trends that may uncover fraud, waste, or non-compliant billing practices.
  • Conduct onsite audits as required, to assess the completeness of medical and administrative records and the compliance with applicable regulatory requirements.
  • Prepare detailed audit documentation, summaries of investigative findings, compile case files, calculate sanctions and overpayments based on violations cited.
  • Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
  • Recommend policy, procedure and system changes to enhance investigative outcomes.
  • Update appropriate internal management staff regularly on progress of investigations.
  • Stay current with regulatory updates, coding changes, and industry standards.
  • Identify trends from national fraud-related publications and recommend new or improved strategies to strengthen fraud-detection efforts.
  • Assist with document management, updating case-tracking system and adhering to record retention policies and procedures.
  • Perform other duties as assigned.

Qualifications:

  • Bachelor's degree in business, health care administration, or other related field
  • 4-6 years of related experience in the healthcare industry, business,; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, administrative medical record reviews or other claims analysis related experience
  • Knowledge of CPT, HCPCS and ICD-10 coding, reimbursement and claims processing policies
  • Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions
  • Ability to interpret and apply law and regulations as it relates to fraud and fraud investigations
  • Ability to multi-task, establish priorities and work independently and collaboratively to achieve audit objectives
  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint and Access)
  • Excellent Customer service skills with the ability to interact professionally and effectively with providers, clients, and internal stakeholders from all departments
  • Ability to travel within Massachusetts and be on-site as needed for audits

Preferred Qualifications:

Prefer individual possessing any of the following certifications or licensure: CPC or CPMA
Knowledge of state and federal regulations as they apply to public assistance programs

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