Medicaid Program Integrity Provider Fraud Investigator

The work we do matters!

Hiring Agency:

Health & Human Services - Agency 25

Location:

Lincoln, NE

Hiring Rate:

$25.043

Job Posting:

JR2025-00021169 Medicaid Program Integrity Provider Fraud Investigator (Evergreen) (Open)

Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):

12-11-2025

Job Description:

The Department of Health and Human Services (DHHS), Medicaid and Long-Term Care Division, is looking for a strategic partner with a high personal standard of integrity and a keen eye for detail to join their team as the Medicaid Program Integrity Provider Fraud Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS.

Under limited supervision, investigates suspected Medicaid provider fraud and program abuse by conducting investigations and audits; prepares and writes investigational reports; compiles prosecution materials and reports; coordinates investigations with Office of Inspector General, FBI and other appropriate law enforcement agencies; presents cases to prosecutors and provides expert testimony in all phases of criminal and civil prosecution and administrative actions; monitors, evaluates and enforces Medicaid providers compliance with conditions of participation and relevant rules, regulations and laws; performs related work as required.

“You have the passion; we have the opportunities – let’s make a difference for Nebraskans”

As the Medicaid Provider Fraud & Abuse Investigator, you will:

• Ensure safety of the Medicaid client and program by identifying, investigating, and intervening in provider fraud, waste, abuse, or erroneous payments.

Hire Rate: $25.043 per hour – Non-Exempt

Work Schedule: Monday – Friday; 8:00 AM – 5:00 PM

Dress Attire: Business Casual

Driving required

Location: Nebraska State Office Building in Lincoln

Requirements / Qualifications:

Minimum Qualifications: Post high school coursework/training in law enforcement, criminal justice, social/behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems. OR Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use and effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems.

Preferred Qualifications:

• Post high school course work in criminal justice or a human services field
• Certified Professional Coder
• Knowledge of the services and providers enrolled in and reimbursed by Nebraska Medicaid
• Experience working with medical claims
• Experience working Investigations

Other: Valid driver's license or the ability to provide independent authorized transportation.

Knowledge, Skills, and Abilities:

Knowledge of: Interview and interrogation techniques; fraud investigation and detection techniques and principles; methods and techniques of program planning.

Ability to : Communicate effectively, prepare objective, factual reports; maintain confidentiality; compile and evaluate data to formulate recommendations and interpret directives; read and understand rules, regulations, and guidelines and apply them to resolve problems; identify and extract pertinent information from records, conversations and observations; make decisions and take action in dealing with problems and situations; plan and organize work; establish and maintain positive relationships with agency staff, service providers and law enforcement agencies.

If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: https://link.nebraska.gov/

Benefits

We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits

Equal Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.