Eligibility Staff Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Eligibility Staff Auditor based in the United States.

This role supports a major Medicaid program integrity initiative focused on strengthening the accuracy, compliance, and accountability of public healthcare programs. You will review Medicaid and CHIP eligibility determinations against federal and state requirements, identifying risks, inconsistencies, and potential areas of non-compliance. The position combines audit expertise, regulatory research, data analysis, and technical reporting in a fully remote environment. You’ll collaborate with state Medicaid agencies and federal stakeholders while helping translate complex findings into actionable recommendations. The role also contributes to improving audit methodologies, analytical tools, review protocols, and team capabilities. It is well suited to an analytical professional who can work independently while maintaining strong quality, organization, and attention to detail. This temporary, mid-level opportunity offers meaningful exposure to federal healthcare oversight and program integrity work.

Accountabilities: Conduct detailed reviews of Medicaid and CHIP beneficiary eligibility determinations to assess compliance with applicable federal and state regulations.

Evaluate eligibility decisions involving applications, redeterminations, post-Public Health Emergency unwinding activities, and subsequent policy changes.

Review state Medicaid eligibility policies, procedures, and workflows for adherence to established requirements and guidelines.

Gather and analyze documentation such as financial records, identity verification materials, eligibility timelines, and other supporting evidence.

Use data analytics tools to identify trends, patterns, anomalies, and risk indicators requiring further audit review.

Identify, document, and communicate vulnerabilities, compliance risks, control gaps, and other areas requiring corrective action.

Prepare comprehensive audit reports, findings, recommendations, and corrective action documentation for federal program stakeholders.

Develop clear and well-supported workpapers and documentation that substantiate audit findings and conclusions.

Collaborate with state Medicaid agencies to obtain records, resolve questions, and clarify eligibility procedures or processes.

Conduct ongoing regulatory and policy research to remain current on Medicaid eligibility requirements and evolving program guidance.

Provide subject matter guidance and communicate regulatory updates to team members as appropriate.

Contribute to the enhancement of analytical tools, templates, review protocols, and program integrity methodologies.

Participate in team meetings, training activities, and continuous improvement initiatives to promote consistent and high-quality audit practices.

Provide guidance and support to junior reviewers when needed.

Ensure reviews are completed according to established protocols, deadlines, productivity expectations, and quality standards.

Verify the accuracy, completeness, and clarity of documentation and findings before submission.

Maintain strong organization, productivity, and communication while working within a fully remote team.

Requirements

Bachelor’s degree in public health, business administration, public administration, accounting, or a related discipline; a master’s degree is preferred.

Candidates with an associate’s degree may be considered with at least 10 years of highly relevant Medicaid eligibility and auditing experience.

At least 3 years of experience working with federal entitlement programs such as Medicaid or CHIP, or 1 year of relevant experience with a master’s degree.

Demonstrated experience conducting compliance assessments, program reviews, audits, or similar oversight activities involving federal or state programs.

Strong knowledge of Medicaid terminology, eligibility frameworks, regulations, policies, and program requirements.

Familiarity with risk assessment methodologies and program integrity principles.

Proficiency with Microsoft Office applications and analytical tools used for data evaluation.

Strong ability to develop clear, concise technical reports, presentations, and supporting audit documentation.

Excellent written and verbal communication skills, with the ability to collaborate effectively with government agencies, internal teams, and other stakeholders.

Strong analytical thinking, attention to detail, prioritization, organization, and time-management skills.

Ability to work independently, exercise sound judgment, and make decisions within established processes and protocols.

Adaptability and demonstrated effectiveness working in a fully remote environment.

U.S. citizenship and ability to obtain Public Trust clearance .

Benefits

Fully remote work environment within the United States.

Competitive compensation package with potential bonus opportunities.

Employer-paid healthcare benefits.

401(k) retirement plan with employer matching.

Access to training and professional development funding.

Opportunity to contribute to a high-impact federal healthcare oversight and program integrity initiative.

Collaborative environment with exposure to Medicaid, CHIP, compliance, audit, analytics, and federal program operations.

Opportunity to develop expertise in healthcare program integrity and government auditing.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1