Data Analyst Fraud Waste & Abuse

Overview

The Fraud, Waste, and Abuse (FWA) Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims. You will be working with a State Government Product and Data Mining team. Your primary responsibility will be to assist in the development and deployment of algorithms designed to support program integrity across various platforms and states plus support our fraud and abuse detection product and services.

Responsibilities include assisting in the development and deployment of algorithms to detect and prevent fraud, waste, and abuse in Medicaid claims; collaborating with a State Government Product and Data Mining team; supporting program integrity across multiple platforms and states; and supporting our fraud and abuse detection products and services.

Required Qualifications:

• 5+ years of experience writing advanced SQL queries
• 5+ years of fraud, waste and abuse data mining experience
• 4+ years of data analysis experience working with database structures
• 4+ years of healthcare claims experience

Preferred Qualifications:

• Industry certifications:
  Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
• Experience with statistical analysis of data
• Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
• Knowledge of healthcare claim adjudication systems
• Experience with Rally