Conduct compliance, fraud and program integrity reviews to ensure adherence to internal processes, SOPs, Document Verification Guides (DV - Gs), and CMS requirements. Define review criteria and methodologies for compliance and program integrity assessments. Pull, analyze, and review records, applications, and supporting documentation to evaluate compliance with eligibility verification and program requirements. Identify trends, patterns, anomalies, and potential compliance or fraud-related risks. Document review findings clearly and accurately, including root causes and risk impacts. Support program integrity and fraud risk management efforts by identifying potential fraud indicators, high-risk submissions, or anomalous activity. Participate in risk-based monitoring activities, including enhanced document integrity checks and pattern recognition. Assist with escalation of potential program integrity, compliance, or fraud concerns following established processes. Contribute to recommendations for process improvements, controls, or tools to mitigate identified risks. Assist in assessing risk and impact for identified compliance or integrity issues. Maintain accurate records and documentation to support reporting and follow-up activities. Support internal compliance reviews and external government audits by gathering requested information and documentation. Assist with responses to external audit findings within required timelines. Collaborate with QA, operations, and leadership teams to align compliance activities with program requirements. Share insights and findings to support continuous improvement of eligibility verification and compliance processes To be successful in this role, you must have: U.S. Citizenship. Bachelor’s degree in business, Healthcare Administration, Public Administration, Criminal Justice, Information Systems, or a related field (experience may be substituted in lieu of degree)3 years experience in compliance, quality assurance, program integrity, fraud identification or eligibility support. Knowledge of ACA Marketplace and/or Eligibility Support (ES) programs. Experience reviewing records, applications, or documentation against defined criteria or requirements, including Document Verification Guides (DV - Gs) and Standard Operating Procedures (SOPs)Strong analytical skills with the ability to identify patterns, trends, and risks. Strong attention to detail and documentation skills. Ability to interpret policies, procedures, and guidance and apply them consistently. Strong written and verbal communication skills. Ability to travel up to 10% Preferred Qualifications. Prior QA experience within ACA Marketplace or ES programs. Experience supporting audits or compliance reviews. Familiarity with fraud risk indicators or program integrity monitoring. Experience working with CMS-directed initiatives or government program oversight. Ability to work independently and manage multiple reviews or priorities