United States · Remote Solely
$24/hr–$32/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! The Payment Integrity Analyst is responsible for …
Skills: Claims analysis, Fraud detection, Waste and abuse detection, Data analysis, Investigative skills
Dover, Delaware, United States · On-site
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Customer …
Skills: Customer service, Dispatching, Communication, Active listening, Data entry
Phoenix, Arizona, United States · On-site
$16/hr–$22/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for facilitating var…
Skills: Customer service, Data entry, Compliance monitoring, Transportation coordination, Issue resolution
Maine, United States · On-site
$17/hr–$25/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for Wheelchair Drivers to jo…
Skills: Vehicle operation, Customer service, Navigation, GPS systems, Vehicle maintenance
United States · Remote Solely
$253k–$303k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! The Deputy General Counsel serves as a key member…
Skills: Corporate governance, Legal operations, Privacy law, Employment law, Regulatory compliance
California, United States · Remote OK
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Facility …
Skills: Facility outreach, Non-emergency medical transportation, Case management, Relationship building, Public speaking
Ridgeland, Mississippi, United States · On-site
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Exception…
Skills: Customer service, Data entry, Problem solving, Interpersonal skills, Communication
Denver, Colorado, United States · On-site
$80k–$109k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for managing Modivca…
Skills: Media Relations, Public Relations, External Communications, Social Media Strategy, Press Release Drafting
Denver, Colorado, United States · Hybrid
$164k–$170k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Software Engineer III wanted by ModivCare Solutio…
Skills: Software development, MS SQL Server, Oracle, DB2, SOAP
United States · Remote Solely
$46k–$52k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for supporting the r…
Skills: Recruitment, Sourcing, Candidate screening, Interview coordination, Onboarding
Maine, United States · On-site
$17/hr–$18/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for a Wheelchair Driver to j…
Skills: Driving, Customer service, Navigation, Vehicle maintenance, Safety compliance
United States · Remote Solely
$80k–$105k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for leading the anal…
Skills: Instructional design, Learning and development, Adult learning theory, Instructional systems design, Articulate Storyline
Denver, Colorado, United States · On-site
$117k–$140k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Database …
Skills: Database administration, SQL programming, Performance tuning, Database security, AWS database services
Oregon, United States · Remote OK
$53k–$70k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Provider …
Skills: Provider relations, Transportation management, Performance management, Data analysis, Conflict resolution
Ridgeland, Mississippi, United States · On-site
$14/hr–$20/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Field Sup…
Skills: Field investigations, Provider relations, Compliance monitoring, Transportation services, Training facilitation
Montana, United States · On-site
$111k–$125k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Market Di…
Skills: Operational leadership, Healthcare operations, Non-emergency medical transportation, Strategic planning, Financial acumen
Charleston, West Virginia, United States · On-site
$14/hr–$17/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Exception…
Skills: Customer service, Exception handling, Issue investigation, Data entry, Communication
Montana, United States · Remote OK
$53k–$76k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an experienced Provider …
Skills: Provider relations, Relationship management, Operational performance, Data analysis, Conflict resolution
Greenville, South Carolina, United States · On-site
$14/hr–$19/hr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for an Dispatcher / Customer…
Skills: Customer service, Scheduling, Data entry, Communication skills, Active listening
United States · Remote Solely
$70k–$94k/yr
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for project manageme…
Skills: Project Management, Program Management, Digital Marketing, Account Management, Content Strategy
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
The Payment Integrity Analyst reviews non-emergency medical transportation claims to identify fraud, waste, abuse, and billing discrepancies. They analyze supporting documentation to ensure compliance with contractual and regulatory requirements while recommending appropriate claim adjustments.
Candidates must have at least four years of experience in claims analysis, payment integrity, or fraud investigations. A high school diploma is required, while a bachelor's degree is preferred.
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!
The Payment Integrity Analyst is responsible for reviewing non-emergency medical transportation (NEMT) claims to identify potential fraud, waste, and abuse (FWA), billing discrepancies, and payment inaccuracies. This role analyzes transportation claims and supporting documentation to determine whether claims meet contractual, regulatory, and company requirements and recommends approval, denial, adjustment, or recovery based on established payment integrity standards.
The ideal candidate is a detail-oriented and analytical professional with strong investigative skills and knowledge of payment integrity principles, claims analysis, and fraud, waste, and abuse detection. They are comfortable reviewing large volumes of claims and operational data, identifying trends and discrepancies, and making well-supported recommendations.
This role works closely with Payment Integrity leadership, the Special Investigations Unit (SIU), Claims Operations, Compliance, Provider Relations, and other internal stakeholders to help ensure accurate claim payments, protect company and client resources, and support program integrity initiatives.
Reviews submitted NEMT claims for indicators of fraud, waste, abuse, billing discrepancies, duplicate billing, overpayments, and other payment integrity concerns.
Analyzes claims, trip documentation, authorizations, provider records, contracts, and other supporting documentation to determine claim validity.
Recommends approval, denial, adjustment, or recovery of claims based on findings and established payment integrity guidelines.
Documents claim reviews, findings, and recommendations accurately and thoroughly within designated systems.
Identifies trends, patterns, or anomalies that may indicate improper billing or potential fraudulent activity and refers appropriate cases to the Special Investigations Unit (SIU).
Ensures claim determinations comply with contractual obligations, client requirements, company policies, and applicable federal and state regulations.
Collaborates with Claims Operations, SIU, Compliance, Provider Relations, and other internal departments to resolve claim issues and support payment integrity initiatives.
Assists in identifying opportunities to improve payment integrity processes, controls, and audit methodologies.
Maintains established productivity, quality, and turnaround time expectations.
Prepares reports and communicates findings to leadership as requested.
Maintains confidentiality of sensitive information and complies with HIPAA and all applicable privacy and security requirements.
Participates in ongoing training related to payment integrity, fraud prevention, and NEMT operations.
Performs other duties as assigned.
High school diploma required.
Bachelor's degree from an accredited college or university preferred.
Four (4) years of directly related experience in claims analysis, Payment Integrity, Special Investigations Unit (SIU), or Fraud, Waste, and Abuse (FWA) investigations.
Strong analytical and investigative skills with exceptional attention to detail.
Knowledge of payment integrity principles and fraud, waste, and abuse detection techniques.
Understanding of NEMT claims processing, provider billing practices, and supporting trip documentation.
Ability to analyze large volumes of claim and operational data to identify trends and payment discrepancies.
Ability to exercise sound judgment and make well-supported recommendations regarding claim approval, denial, or recovery.
Strong written and verbal communication skills.
Proficiency in Microsoft Office Suite, particularly Excel.
Ability to manage multiple priorities while meeting deadlines.
Demonstrated integrity, professionalism, and commitment to confidentiality.
Experience with non-emergency medical transportation (NEMT) claims and operations preferred.
Experience working with Medicaid managed care programs preferred.
Knowledge of NEMT provider billing practices, trip documentation requirements, and authorization processes preferred.
Experience using claims management systems and data analysis tools preferred.
Professional certification related to fraud examination, investigations, auditing, or payment integrity preferred.
Salary: $24.88-$32.00
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of the position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the job.
Primarily seated work; extensive computer and telephone use; occasional standing, walking, reaching, bending, and lifting up to 10 lbs.
Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received. We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings.
We value our team members and realize the importance of benefits for you and your family.
Modivcare offers a comprehensive benefits package to include the following:
Modivcare is an Equal Opportunity Employer.
To bring equity, hope and healing to those who need it most. To make a world of difference, one member at a time.
Modivcare is a technology-enabled healthcare services company, which provides a suite of integrated supportive care solutions for public and private payors and their patients. Our value-based solutions address the social determinants of health (SDoH), enable greater access to care, reduce costs, and improve outcomes. We are a leading provider of non-emergency medical transportation (NEMT), personal care services, and monitoring.
Offices: Denver, Colorado, US
To bring equity, hope and healing to those who need it most. To make a world of difference, one member at a time.
Modivcare is a technology-enabled healthcare services company, which provides a suite of integrated supportive care solutions for public and private payors and their patients. Our value-based solutions address the social determinants of health (SDoH), enable greater access to care, reduce costs, and improve outcomes. We are a leading provider of non-emergency medical transportation (NEMT), personal care services, and monitoring.
Offices: Denver, Colorado, US
