Ops Medical​/Health Care Program Analyst

- OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Full‑time OPS position, Monday‑Friday 8:00 a.m. to 5:00 p.m. Salary $20.00/hour, non‑negotiable. Travel may be required 1‑15%.

The Florida Medicaid program is one of the largest, with an estimated $38 billion annual budget and nearly 4 million recipients. The Bureau of Medicaid Program Integrity (MPI) investigates and audits healthcare providers to guard against fraud, abuse, waste, and over payments.

• Provide compliance oversight of Managed Care Plans (MCPs) to ensure adherence to state and federal law, contract provisions, and Medicaid policy.
• Conduct investigations into potential fraud or abuse by MCPs or their provider networks.
• Perform audits, visit providers, identify over payments, write investigative summary reports, and recommend referrals to other entities.
• Collaborate with other MPI operational units and regulatory agencies, and participate in joint data‑driven field initiatives and special projects.
• Utilize open‑source and proprietary resources to conduct investigations and audits; monitor and track case status.
• Use FACTS to assign or deactivate user accounts, prepare and submit operational, managerial, and ad‑hoc reports, and communicate findings and updates to users.
• Analyze trends or patterns in data sets to support investigations.
• Conduct payment restriction reviews in accordance with state and federal rules, laws, and statutes.
• Collaborate with team members on projects and assignments.

• Problem‑solving and decision making based on available information.
• Project execution within a fast‑paced environment.
• Conduct investigations, coordinate investigative activities, and accurately document results.
• Fact‑finding research.
• Independent work capability.
• Effective verbal and written communication.
• Knowledge of applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.
• Proficiency with Microsoft Word, Excel, Outlook, and Edge.
• Ability to travel with or without accommodations.
• Knowledge of the Florida Medicaid Program.
• Knowledge of research or investigative principles, practices, and techniques.
• Strong investigative, research, written, oral, and organizational skills.

• Two (2) years of investigative, enforcement, health care, or professional experience within a regulatory or oversight setting.
• Preference for candidates holding a bachelor’s degree or higher from an accredited college or university, especially in health law, health science, criminology, criminal justice, or a substantially similar discipline.
• Preference for candidates with a program integrity related professional certification, such as Certified Fraud Examiner, Accredited Healthcare Fraud Investigator, Certified Financial Crimes Investigator, Certified Insurance Fraud Investigator, or Certified Compliance and Ethics Professional.

• No state income tax for Florida residents.
• State Group Insurance coverage options (eligibility required).
• 401(a) FICA Alternative Plan administered through VALIC.
• Florida Deferred Compensation Plan (457(b)).

• Background and fingerprint screening, including state and national criminal history checks.
• Drug‑free workplace; reasonable‑suspicion drug testing as required by law.
• Background screening must be completed before employment.
• ADA accommodations available upon notification.

For assistance, call the People First Service Center at (877) 562‑7287 Monday‑Friday 8:00 a.m. – 6:00 p.m., Eastern time. Pursuant to Florida Law, 110.211 F.S., the State of Florida is an EEO employer.