Senior Fraud Analyst

Job Summary

Proactively identifying instances of fraud, waste, and abuse, the full-time Senior Fraud Analyst will analyze medical billing data and collaborate with engineering and data science teams to enhance anomaly detection algorithms in a remote work environment.

Key responsibilities

• Identify potential instances of fraud, waste, and abuse through data analysis
• Support engineering and data science teams with audit and FWA concepts and data mapping
• Validate and tune anomaly detection algorithms based on real-life experience

Required qualifications

• Hands-on experience with medical billing errors and fraud analysis using analytic and SQL/graph-based tools
• Extensive knowledge of medical terminology, coding guidelines, and claims adjudication processes
• Strong analytical skills with a scientific approach to tasks
• Background in Special Investigations Unit (SIU) or Payment Integrity
• Independent, organized, and possessing excellent communication skills