Fraud, Waste & Abuse Lead Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Overseeing intricate analytics, reporting, AI/Machine Learning project coordination, and global trend analysis to facilitate the proactive detection, prevention, and management of fraud, waste, and abuse risks.

• Serving as the primary liaison among business stakeholders, data science teams, operational partners, and leadership to convert complex data into actionable insights and strategic recommendations.

• Independently spearheading sophisticated reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, evaluate, and mitigate medical and financial risks.

• Collaborating across multiple workstreams and advising key stakeholders on risk trends, functional strategies, and opportunities for mitigation.

• Establishing best practices that enhance proactive analytics, reporting quality, and overall departmental maturity.

• Exercising independent judgment and decision-making on complex issues related to job responsibilities and associated tasks, working with minimal supervision.

⛳️ Requirements

• Bachelor’s degree in a relevant field.

• At least eight years of progressive technical experience in data analysis.

• A minimum of two years of experience leading projects, initiatives, or cross-functional workstreams.

• A minimum of two years of experience in reviewing claims related to fraud, waste, and abuse.

• Proven experience with claims platforms and claims processing operations.

• Advanced proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint.

• Strong verbal and written communication skills, capable of effectively presenting information and recommendations to senior and executive leadership.

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).

• Short-term and long-term disability.

• Life insurance.