NOW HIRING! TBI Medicaid Fraud Auditor
The Tennessee Bureau of Investigation seeks interested and qualified candidates for the following open positions.
TBI Medicaid Fraud Auditor
Medicaid Fraud Control Division
Vacancies 1
TBI Headquarters – Nashville
Job Duties:
Assists the TBI Medicaid Fraud Control Division’s Data Mining Workgroup by reviewing and screening potential fraud leads generated through proactive analytics tools, evaluating the credibility and significance of each lead, and helping to develop the supporting information into a comprehensive, formal fraud referral for further investigative action. Evaluates incoming tips and referrals from internal and external sources by reviewing the information provided, assessing its credibility and relevance, and determining whether further investigative action is warranted. Compiles and audits potential Medicaid fraud financial information. Audits claim data to create custom summary reports. Compiles and audits Electronic Health Records (EHR)/ Electronic Medical Records (EMR) and patient abuse referral reports. Identifies anomalies, outliers, and trends in claims data and medical and financial records. Analyzes personal identifying information (PII) to identify potential witnesses, subjects, and victims. Exchanges information with state and federal organizations (e.g., United States Attorney’s Office (USAO), State Attorney General (AG), Office of Program Integrity (OPI), Healthcare Informatics (HCI), the Department of Labor (DoL) to assist in facilitating Medicaid fraud investigations. Hybrid position opportunity with time in office at least once a week and/or as needed.
Minimum Qualifications:
A Bachelor’s degree and 4 years of experience with a healthcare insurance provider (MCO), TennCare, Center for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPIC), a Medicaid Fraud Control department, or related field.
OR
An associate’s degree and 6 years of experience with a healthcare insurance provider (MCO), TennCare, Center for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPIC), a Medicaid Fraud Control department, or related field; and a nationally recognized certification as an Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or other relevant certification.
OR
A high School diploma or equivalent and 8 years of experience with a healthcare insurance provider (MCO), TennCare, Center for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPIC), a Medicaid Fraud Control department, or related field; and a nationally recognized certification as an Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), or other relevant certification.
Monthly Salary: $6,544- $10,363
For Additional Information Contact:
TBI Human Resources Unit at TBI.HR@tbi.tn.gov.
To Apply:
Please visit the Tennessee Department of Human Resources website at Careers (tn.gov). Apply to Job Opening 79993. This position will remain posted from August 12, 2026 – August 18, 2026, for five (5) business days.
Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status or any other category protected by state and/or federal civil rights laws.
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