Senior Fraud, Waste, and Abuse Data Analyst - Remote

About the Role

We are seeking a Senior Fraud, Waste, and Abuse (FWA) Data Analyst to join our team at HHAeXchange. This is a fully remote opportunity for candidates located in the EST or CST time zones within the US only. In this role, you will analyze large healthcare datasets to identify suspicious billing patterns and contribute to the development of our fraud detection capabilities. As a Senior FWA Data Analyst, you will play a pivotal role in helping us protect public funds and ensure program integrity.

What You'll Do

• Analyze Medicaid claims, visit, and billing datasets using SQL and other analytical tools to identify patterns and anomalies that may indicate fraud, waste, or abuse.
• Develop and refine detection queries and analytical logic that can be applied across datasets at scale.
• Apply machine learning and AI techniques to fraud detection, including anomaly detection models and predictive risk scoring.
• Collaborate with product, engineering, and payer stakeholders to translate analytical findings into actionable requirements.
• Present analytical findings and insights to internal stakeholders and payer clients in a clear and actionable format.

Requirements

• 5–7 years of experience in healthcare analytics, payment integrity, fraud detection, or a related field.
• Strong SQL proficiency, including the ability to independently query and analyze large, complex datasets.
• Solid understanding of the end-to-end revenue cycle, including claims submission and adjudication processes.
• Experience using AI or machine learning tools for anomaly detection in healthcare claims data.
• Ability to communicate complex analytical findings to both technical and non-technical audiences.

Nice to Have

• Experience with Python, R, or advanced analytics and data visualization tools.
• Familiarity with Medicaid RAC, UPIC, or MIC audit processes.
• Professional certifications such as Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI).

What We Offer

• Competitive base salary range of $130,000-155,000 per year.
• Comprehensive health plans and paid time off.
• 401K retirement program with a company elected match.
• Flexible remote work arrangements.
• Opportunities for professional growth and development.