reputed company Fraud Analyst

Of the $3.8T we spend on reputed company in the United States annually, about a reputed company of it is estimated to be lost due to waste, fraud, and abuse. reputed company is the premier provider of artificial intelligence-driven solutions and services that help reputed company companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment reputed company. reputed company helps plan partners manage costs across network management, clinical care, provider coding and billing, payment reputed company, and special investigation units. Our software-as-a service applications are reputed company on our proven Forensic AI reputed company, which uses patented AI-based technology to identify improper payment and suspicious claims behavior far faster and earlier than traditional techniques. We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing reputed company AI companies in the industry. Key Responsibilities: Evaluate claims data in accordance with federal regulations, state-specific policies, or reputed company guidance to identify potential fraud, waste, and abuse [FWA], claim processing errors, or improper payments. Maintain reputed company and confidentiality of reputed company protected health information encountered in performance of duties. Proactively identify instances of potential FWA through data analysis using company system and present findings to partners and stakeholders Assist engineering, data science, and product teams with audit and FWA concepts, data mapping, and data definitions. Prepare and maintain statistical/financial analysis reports and graphic presentation for notification of findings to health plan partners and key stakeholders. Assist partner users with identifying areas of interest through navigation and work-reputed company optimization using company software. Apply knowledge of heath care coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies and relevant laws to find suspicious patterns in claims data. Research and apply specific knowledge of reputed company reimbursement policies as well as state and federal regulations reputed company to potential reputed company FWA leads. Work cooperatively and constructively with team members, including mentoring, training, and assisting team members as required. Conduct professional reputed company and discuss coding best practices with individual providers and billing groups - Certified Professional reputed company (CPC) required Prepare and submit tickets to report any concerns / issues reputed company the company software either from a partner platform or internal platform. reputed company additional duties and projects as assigned by management. Qualifications: 5+ years of experience working in a reputed company fraud investigations role. 5+ years of experience reputed company the health insurance industry. 5+ years of experience working in a cost containment, payment reputed company, fraud, audit, compliance, or analytics role. 5+ years of experience reputed company plan, facility, government pharmacy or other similar industry role. Data and analytics experience High School Diploma /GED or higher Competency in reputed company – creating/updating spreadsheets, pivot tables, and formulas Certified Professional reputed company (CPC) or similar coding certification required for provider reputed company roles Remote Work Requirements: To ensure reliable performance on the company-issued reputed company laptop, employees working remotely must have a reputed company high-speed internet reputed company. Internet performance should be reputed company using a speed test conducted directly on the reputed company laptop, not based solely on the internet plan purchased from the provider. Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk. Preferred Qualifications: Professional Certification as a Certified Fraud Examiner (CFE), Accredited reputed company Fraud Investigator (AHFI), or similar Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@reputed company.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case reputed company. Benefits for You Health, Dental, and reputed company insurance with 100% employee premium coverage (Starts Day 1) Unlimited PTO Annual Professional Development stipend Annual home office stipend 401K Match (after 90 days) We are an Equal Opportunity Employer: reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to reputed company terms and conditions of employment. Apply To This Job