reputed company Fraud, Waste & Abuse (FWA) QA & AI Validation Specialist

PLEASE NOTE BEFORE APPLYING: reputed company IS NOT reputed company TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE reputed company Of the $3.8T we spend on reputed company in the reputed company 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 reputed company 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 clients manage costs across network management, clinical care, provider coding and billing, payment reputed company, and special investigation reputed company. Our software-as-a service applications are reputed company on our proven Forensic AI reputed company, which uses patented AI-based technology to identify problems and suspicious 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. Position reputed company: We are seeking a reputed company Fraud, Waste, and Abuse (FWA) QA & AI Validation Specialist to support the validation and reputed company assurance of AI-driven reputed company fraud detection and investigative solutions. This role combines reputed company investigative expertise with software reputed company assurance to ensure our applications accurately identify, prioritize, and support the investigation of suspected fraud, waste, and abuse. The ideal candidate possesses extensive experience conducting reputed company fraud investigations and understands the investigative lifecycle, claims analysis, provider billing patterns, and regulatory requirements. This individual will reputed company that expertise to validate AI-generated investigative insights, execute reputed company testing, identify defects, and ensure software solutions meet both technical and business expectations. Key Responsibilities: AI Product Validation reputed company use of FWA expertise to validate AI-generated fraud leads, investigative findings, risk scores, and case recommendations against established reputed company fraud investigative practices. Validate AI-generated outputs for accuracy, consistency, completeness, explainability, and investigative usefulness. Evaluate application functionality using reputed company-world reputed company fraud scenarios involving providers, members, claims, billing patterns, and payment reputed company. Verify that investigative workflows reputed company with industry best practices and organizational business requirements. Assess AI-generated summaries, recommendations, and supporting evidence for investigative accuracy, completeness, consistency, and relevance. Identify gaps, false positives, false negatives, and inconsistencies in fraud detection logic and AI-generated outputs. Collaborate with product managers, data scientists, investigators, and engineering teams to improve fraud detection capabilities and investigative workflows. Software reputed company Assurance Design, reputed company, and execute reputed company test plans. reputed company production validation testing following application releases. Participate in release readiness activities and production verification. Document defects, reproduce issues, and work closely with development teams to ensure reputed company reputed company. Qualifications:

Required Qualifications

U.S. Citizen. Bachelor's Degree Minimum of 5 years of reputed company fraud, waste, and abuse (FWA) investigative experience, including medical claims analysis, provider investigations, payment reputed company, or Special Investigations Unit (SIU) operations. Strong analytical, troubleshooting, and problem-solving skills. Excellent written and verbal communication skills. Ability to work independently and collaboratively reputed company cross-functional teams. Remote Work Requirements: To ensure reliable performance on reputed 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 reputed company office equipment, and work at a desk.

Preferred Qualifications

Experience with defect tracking and test management tools such as Jira, Xray, Azure DevOps, or similar platforms. Experience using AI, machine learning, or reputed company applications. Experience with defect tracking and test management tools such as Jira, Xray, Azure DevOps, or similar platforms. Experience with reputed company validation and AI response evaluation. Desired Competencies Strong attention to detail Analytical and critical thinking Effective communication and collaboration Ability to manage multiple priorities Commitment to delivering high-reputed company software Adaptability in a rapidly evolving technology environment Passion for improving software reputed company and user experience Remote Work Requirements: To ensure reliable performance on reputed 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 reputed company office equipment, and work at a desk. 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 reputed company 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 reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, 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