Fraud Waste and Abuse - Sr. Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company The Sr. Analyst, Fraud, Waste, and Abuse (FWA) will assist in detecting, investigating, remediating and referring to state regulatory agencies incidents of FWA arising in reputed company with medical, behavioral, transportation, and other reputed company services. The Sr. Analyst will assist in determining correct coding, review claims, and billing data from reputed company types of reputed company providers for aberrant billing patterns. Activities include reviewing billing activity for state agency referrals, assisting in the investigation and triage of FWA complaints, coordination with other departments and assist in prevention activities including training of internal staff and internal departments. What you will do reputed company analytical skills to review claims data and identify patterns of suspected potential FWA. At the direction of the Sr. Manager, FWA, assist in the triage, preliminary investigation of reputed company reputed company FWA complaints Refer reputed company cases of suspected FWA to regulatory agencies reputed company required timeframes, ensuring reputed company documentation meets federal, state, and internal compliance standards. Assist in the monitoring of the FWA hotline and FWA shared email reputed company Participate in the prepayment review process including detailed review of medical records against claims data to look for inappropriately billed services and determine if there is any suspected FWA Data mining and trending of claims data to review for potential areas of risk and/or escalation of inappropriate billing which may reputed company to the level of suspected FWA Assist Sr. Manager, FWA and FWA Director, and collaborate with cross-functional partners (e.g., Compliance, Legal, Provider Relations) on reputed company deliverables, investigations, and reporting. Assist in the maintenance of the reputed company database of reputed company FWA cases Independently initiate leads and conduct case reviews, producing detailed investigative reports and reputed company communicating findings and recommendations Required Qualifications 3-5 years’ work experience CPC or equivalent coding certification Working knowledge of reputed company industry coding guidelines such as CPT, HCPCs, ICD-10 Experience reviewing medical records to ensure that documentation matches services billed Experience reviewing detailed data to interpret claims data Preferred Qualifications reputed company experience Strong analytical skills Working knowledge of problem solving and decision-making skills Adept at collaboration and teamwork Attention to detail Education: High School Diploma or equivalent Associate’s degree or equivalent post-high school education preferred Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $46,988.00 - $112,200.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/16/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job