Program Integrity Analyst I

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Department ofHealth and Human Services (DHHS)

Comprehensive Health Planner I

Opening Date:January 27 2026

Closing Date:February 9 2026

Job Class Code:5049

Grade:23 (Pro. & Tech. Services)

Salary:$49275.20 $69139.20 per year

Position Number:03000-4513

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.

of and experience with nationally accepted billing forms and coding.

written communication skills to include the ability to develop written reports that summarize compliance/non-compliance.

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.

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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 States 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 .

To apply please upload a resume cover letter addressing the four competency areas identified in the Minimum Qualification 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

Benefits of working for the State of Maine:

No matter where you work across Maine state government you find employees who embody our state mottoDirigo or I leadas they provide essential services to Mainers every day. We believe in supporting our workforces health and wellbeing with a valuable total compensation package including:

• Work-Life Fit Rest is essential. Take time for yourself using13 paid holidays 12 days of sick leave and3 weeks of vacation leaveannually. Vacation leave accrual increases with years of service and overtime-exempt employees receive personal leave.
• Health Insurance Coverage The State of Maine pays85%-100%of employee-only premiums ($12845.82 - $15112.76 annual value) depending on salary. Use this chart to find thepremium costsfor 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 aboutprogram 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 employees pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leaveis one of the most important benefits for any working parent. All employees who are welcoming a childincluding non-birthing and adoptive parentsreceivesix weeks of fully paid parental leave. Additional unpaid leave may also be available under theFamily and Medical Leave Act.

State employees are eligible for anextensive 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 foranything less than full-time.

Theres a job and then theres 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.

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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.