Program Integrity Analyst I

If you are a current State of Maine employee, you must complete your application through the internal application process (Find Jobs Report). Please apply using your PRISM account. If you are on Seasonal Leave and do not have access to PRISM, contact your local Human Resources representative for application information. Department of Health and Human Services (DHHS) Comprehensive Health Plan I Opening Date: December 15, 2025 Closing Date: December 30, 2025 Job Class Code: 5049 Grade: 23 (Pro. & Tech. Services) Salary: $49,275.20 $69,139.20 per year Position Number: 02000-2721 Location: Augusta Core Responsibilities: As a Comprehensive Health Planner I in the Program Integrity Unit, you will direct and conduct studies to identify and verify areas of fraud, abuse and waste in the MaineCare Program by using a data analytics review system among other programs. You will analyze large volumes of claims data to identify unusual or suspicious billing patterns, outliers, high volume or cost providers that may require additional follow-up. You will review/investigate allegations of fraud and abuse and conduct routine reviews of providers to verify compliance with MaineCare rules and regulations. You will determine areas of non-compliance and calculate overpayment amounts. You will prepare detailed spreadsheets of case review findings and when appropriate draft recoupment/sanction letters. You will assist the Healthcare Crimes Unit, OIG and the U.S. Attorneys Office in case investigations when MaineCare policy and procedure expertise is required and/or when additional administrative review is needed. Minimum Qualifications: A Bachelors Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work ,or a closely related field and two (2) years professional experience in the planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent six (6) year combination of education, training, and experience. The background of well-qualified candidates will demonstrate the following competencies: 1. A demonstrated ability to identify, research and analyze a broad range of documents and data related to healthcare services and/or eligibility in order to verify compliance and/or identify potential fraud. 2. Knowledge of and experience with nationally accepted billing forms and coding. 3. Exceptional written communication skills to include the ability to develop written reports that summarize compliance/non-compliance. 4. Knowledge and experience with medical terminology, Excel or comparable spreadsheet applications, MS Word or comparable word process application, Access or comparable database application and SharePoint or comparable file sharing application. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If youre currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your experience and passion set you apart. Agency information: The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers. The Office of MaineCare Services (OMS) within DHHS administers the states Medicaid program and coordinates several major healthcare financing programs for Maine, including the Childrens Health Insurance Program (CHIP). OMS works collaboratively with the Commissioners Office of DHHS and the Office of the Governor on health reform and coordinates with other health plans on statewide healthcare improvement initiatives. OMS ensures that the healthcare programs and services it administers operate in alignment with DHHS goals and federal mandates and are consistent with State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. The Program Integrity Unit in the Office of MaineCare Services is responsible for providing audit oversight services of public assistance funds administered by the MaineCare Program. Application Information: For additional information about this position please contact Valerie Hooper, Supervisor, Program Integrity Unit, (207) 287-2414. To apply, please upload a resume, cover letter addressing the four competency areas identified in the Minimum Qualifications Section, and copies of post-secondary transcripts. Applications must be received by the closing date. Please submit all documents or files in PDF or Word format. To request a paper application, please contact Mandy.Hernandez@Maine.gov Benefits of working for the State of Maine: No matter where you work across Maine state government, you find employees who embody our state motto"Dirigo" or "I lead"as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including: Work-Life Fit Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. Health Insurance Coverage The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State. Health Insurance Premium Credit Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements. Dental Insurance The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value). Retirement Plan The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS). Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a childincluding fathers and adoptive parentsreceive six weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act. State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness. Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time. There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If youre looking for a great next step, and want to feel good about what you do, wed love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request. . If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting. Join Maine State Government and Make a Difference in Your Community If you're looking for a fulfilling career that allows you to serve the public and make a difference, consider working with Maine State Government! Our departments boast an array of professions, including attorneys, biologists, correctional officers, equipment operators, engineers, human resources professionals, information technology experts, law enforcement officers, nurses, park rangers, social workers, and transportation workers. With more than 100 agencies, boards, and offices, Maine State Government is the perfect place to explore various industries and interests. Whether you're interested in finance or forestry, there's an opportunity for you to help make Maine an even better place to live. eases, theres a place for you here, and your work will have meaning.