Senior Fraud, Waste, and Abuse Data Analyst
New
Candidates located in the EST or CST time zones within the US only, EST, CSTFull-TimeSenior
Salary130,000 - 155,000 USD per year
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Job Details
- Experience
- 5–7 years
- Required Skills
- SQLArtificial IntelligenceMachine LearningData visualization
Requirements
- 5–7 years of experience in healthcare analytics, payment integrity, fraud detection, or related field.
- Strong SQL proficiency.
- Understanding of the end-to-end revenue cycle (claims submission, adjudication, remittance).
- Working knowledge of Medicaid billing structures (HCPCS, CPT, 837P/837I).
- Familiarity with federal Medicaid program integrity regulations (42 CFR).
- Experience using AI or machine learning tools for anomaly detection or predictive analytics.
- Ability to communicate complex findings to technical and non-technical audiences.
Responsibilities
- Analyze Medicaid claims, visit, and billing datasets using SQL and other analytical tools.
- Identify patterns and anomalies that may indicate fraud, waste, or abuse.
- Develop and refine detection queries and analytical logic.
- Conduct proactive data analysis to identify emerging fraud patterns and program integrity risks.
- Apply machine learning and AI techniques to fraud detection.
- Translate analytical findings into clear, actionable requirements for product and engineering teams.
- Present analytical findings and insights to internal stakeholders and payer clients.
- Document analytical methodologies and investigation approaches.
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