Fraud Waste and Abuse Analyst

Job Summary

Assisting in the detection and investigation of fraud, waste, and abuse incidents, the full-time Senior Analyst will review claims data, coordinate with regulatory agencies, and support internal training efforts in a remote capacity.

Key responsibilities

• Leverage analytical skills to identify patterns of suspected fraud, waste, and abuse in claims data
• Assist in the triage and preliminary investigation of internal and external FWA complaints
• Conduct detailed reviews of medical records against claims data to identify inappropriate billing practices

Required qualifications

• 3-5 years of relevant work experience
• CPC or equivalent coding certification
• Working knowledge of standard industry coding guidelines such as CPT, HCPCs, and ICD-10
• Experience in reviewing medical records to ensure documentation matches billed services
• Experience in analyzing detailed claims data