Director, Program Integrity, Health & Human Services

KPMG Advisory practice is at the forefront of transformation, offering excellent opportunities for individuals to advance their careers and expertise. With a wealth of learning and career development opportunities, a world-class training facility, and leading market tools, we help our people continue to grow both professionally and personally. Our professionals thrive in a collaborative, team-driven culture where adaptability is key. If you're looking for a firm with a strong team connection where you can have an impact, advance your skills, and expand your capabilities, consider a career in Advisory.

Responsibilities

• Provide technical and strategic advisory services related to program integrity, compliance, and fraud, waste, and abuse (FWA) across Health and Human Services (HHS) programs, including Medicaid, HR1-related programs (such as SNAP), rural health, childcare, child welfare, and child support enforcement.
• Support the design, implementation, and operation of end-to-end program integrity frameworks, including policy and procedure development, governance models, internal controls, and operating structures.
• Lead and oversee risk assessments, gap assessments, and fraud risk assessments to identify program vulnerabilities and prioritize integrity and compliance activities.
• Direct and support compliance reviews, audits, investigations, and third-party/subrecipient monitoring, including desk and field audits; design and oversee FWA prevention and detection strategies, leveraging data analytics, automated flags, trend analysis, dashboarding, and reporting.
• Develop and monitor corrective action plans (CAPs) and continuous improvement efforts to remediate findings and strengthen program controls.
• Support provider and participant integrity activities, including credentialing, background checks, eligibility-related reviews, and forensic analysis.
• Provide guidance on regulatory compliance with federal and state requirements and translate policy and regulatory expectations into practical, operational solutions.
• Provide program integrity leadership across financial, reimbursement, and fiscal administration functions, including rate setting, cost reporting, managed care oversight, and federal claiming, to identify and mitigate fraud, waste, and improper payments.
• Contribute to KPMG's thought leadership by authoring professional articles, participating in industry and regulatory forums, and speaking at external events on program integrity and FWA topics.
• Lead and actively participate in business development efforts, including client relationship management, proposal development, and expansion of program integrity services across HHS clients.
• Oversee team operations by planning, scheduling, and assigning work; provide leadership in recruiting, developing, and retaining talent to grow the program integrity practice.
• Act with integrity, professionalism, and personal responsibility to uphold KPMG's respectful and inclusive work environment.

Requirements

• Minimum eight years of recent and applicable experience in program integrity, compliance, audits, investigations, or FWA-related roles, supporting federal or state HHS programs, including Medicaid and/or human services programs (such as SNAP, child welfare, childcare, child support enforcement).
• Advanced degree from an accredited college or university is preferred; minimum of a Bachelor's degree is required.
• Preferred certifications include CFE, CGFM, PMP, CPA, or other relevant credentials.
• Strong working knowledge of federal and state laws, regulations, and guidance governing Medicaid and human services programs.
• Experience designing and executing program integrity strategies, compliance reviews, and FWA prevention and detection initiatives.
• Experience in Medicaid finance, healthcare finance, reimbursement, or fiscal administration, including roles such as Medicaid CFO, Deputy CFO, finance director, or consulting roles supporting state HHS or Medicaid agencies.
• Demonstrated experience with Medicaid rate setting, cost reporting, managed care financial oversight, federal claiming, or financial audits, and their intersection with program integrity and compliance.
• Demonstrated experience leading teams and managing complex, multi-disciplinary engagements, with an active role in execution and delivery.
• Proven success in client service and business development within an advisory or consulting environment.
• Exceptional interpersonal and communication skills, with the ability to build credibility and trust with senior government and organizational leaders.
• Willingness to travel as needed, which may be up to eighty percent.
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Benefits

• Comprehensive medical and dental plans, vision coverage, disability and life insurance.
• 401(k) plans and a robust suite of personal well-being benefits to support mental health.
• Personal Time Off per fiscal year, based on job classification, standard work hours, and years of service.
• Two annual breaks where employees will not be required to use Personal Time Off: one at year-end and another around the July 4th holiday.

Salary ranges are determined based on relevant factors such as applicant's skills, job responsibilities, prior relevant experience, certain degrees and certifications, and market considerations. For city-specific salary ranges outside of California, visit KPMG's Pay Transparency page.