Program Integrity Analyst

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.

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:

Location:

Augusta

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 Maine Care 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 Maine Care rules and regulations. You will determine areas of non-compliance and calculate over payment 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. Attorney’s Office in case investigations when Maine Care policy and procedure expertise is required and/or when additional administrative review is needed.

A Bachelor’s 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:

Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re 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.

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 Maine Care Services (OMS) within DHHS administers the state’s Medicaid program and coordinates several major healthcare financing programs for Maine, including the Children’s Health Insurance Program (CHIP). OMS works collaboratively with the Commissioner’s 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…