Sr. Fraud, Waste, and Abuse Data Analyst - Remote

Overview

The Sr. Fraud, Waste, and Abuse Data Analyst is responsible for analyzing Medicaid claims and billing datasets to identify patterns indicating fraud, waste, or abuse, utilizing advanced analytical tools and AI techniques.

In Short

• Analyze Medicaid claims and billing datasets using SQL.
• Identify patterns indicative of fraud, waste, or abuse.
• Develop and refine detection queries and analytical logic.
• Apply machine learning and AI techniques for fraud detection.
• Collaborate with data science teams for model validation.
• Translate findings into actionable requirements for product teams.
• Present analytical findings to internal stakeholders and clients.
• Document methodologies to support compliance and audit readiness.
• Travel up to 10%, including overnight travel.
• Other duties as assigned.

Requirements

• 5–7 years of experience in healthcare analytics or related fields.
• Strong SQL proficiency for analyzing large datasets.
• Experience with fraud detection and program integrity.
• Understanding of the healthcare revenue cycle.
• Familiarity with Medicaid billing structures and regulations.
• Experience using AI or machine learning tools.
• Strong analytical and problem-solving skills.
• Ability to communicate complex findings clearly.
• Comfort in an evolving environment.
• Preferred experience in payment integrity organizations.

Benefits

• Opportunity to work with advanced AI and analytics tools.
• Engage in impactful work within healthcare integrity.
• Collaboration with experienced data science teams.
• Professional development opportunities.
• Supportive team environment.