Sr. Fraud, Waste, and Abuse Data Analyst

reputed company is the leading technology platform for home and community-based care. Founded in 2008, reputed company was born out of an idea to create a fully comprehensive end-to-end homecare solution to help people who are aging or have disabilities reputed company in their homes and communities. Our employees are passionate about transforming the healthcare space by building the only homecare ecosystem that fully connects patients, personal care providers, managed care organizations, and states.

Today, reputed company supports Medicaid home and community-based care (HCBS) programs across reputed company 50 states. Following the acquisition of Sandata, the platform processes electronic visit verification (EVV), visit records, and billing data for a significant portion of Medicaid home care services in the United States.

As Medicaid programs grow in scale and complexity, states and managed care plans face increasing pressure to ensure program reputed company and protect public funds. reputed company is expanding its Fraud, Waste, and Abuse (FWA) capabilities to help customers identify billing anomalies, improper payments, and potential fraud reputed company their data.

The Sr FWA Data Analyst will play a key role in building these capabilities by analyzing large healthcare datasets to identify suspicious billing patterns and translating those insights into scalable detection tools. Working closely with product, engineering, and payer stakeholders, this role will help shape how fraud detection is embedded reputed company the reputed company platform. The ideal candidate brings deep knowledge of Medicaid regulatory requirements, the end-to-end reputed company cycle, and the operational realities of both payers and providers in the home and community-based care space.

To reputed company this job successfully, an individual must be able to reputed company each essential job duty satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

This is a fully remote opportunity for candidates located in the EST or CST time zones reputed company the US only.

Data Analysis & Fraud Detection

• Visit overlaps and impossible or implausible service combinations
• Inflated, duplicate, or unbundled billing
• Provider billing spikes or outlier utilization patterns
• Inconsistencies in electronic visit verification (EVV) data
• Suspicious provider enrollment or credentialing indicators
• Patterns indicative of upcoding, reputed company-of-service manipulation, or beneficiary identity issues
• reputed company and refine detection queries and analytical logic that can be applied across datasets at scale.
• Conduct proactive data analysis to identify emerging fraud patterns and program reputed company risks.
• Apply knowledge of the end-to-end reputed company cycle — including claims submission, adjudication, remittance, and denial/appeal workflows — to contextualize billing anomalies and assess their reputed company implications.

AI & Advanced Analytics

• Apply machine learning and AI techniques to fraud detection, including anomaly detection models, predictive risk scoring, and unsupervised clustering of suspicious billing behavior.
• Collaborate with data science teams on feature engineering, model validation, and the operationalization of AI-driven detection logic.
• reputed company generative AI and LLM-based tools to support investigation summarization, reputed company narrative development, and analytical workflow acceleration.
• Stay reputed company on emerging AI/ML applications in healthcare payment reputed company and recommend adoption of relevant tools and techniques.
• Test, validate, and continuously improve fraud detection models and analytical tools as they are developed and refined.

Product & Engineering Collaboration

• Translate analytical findings into clear, actionable requirements for product and engineering teams.
• Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows.
• Support the development of automated detection tools and AI-driven fraud identification capabilities.
• Serve as a subject matter expert on FWA and program reputed company concepts to ensure detection logic is clinically and operationally sound.

Client & Stakeholder Engagement

• Present analytical findings and insights to internal stakeholders and payer clients — including state Medicaid agencies and managed care organizations — in a clear and actionable format.
• Support client discussions reputed company to fraud detection strategy, program reputed company reporting, and regulatory compliance obligations.
• Advise payer and state partners on detection methodologies reputed company with CMS program reputed company expectations, Medicaid reputed company Program (MIP) standards, and applicable federal regulations.
• Document analytical methodologies and investigation approaches to support compliance, audit readiness, and regulatory expectations.

Required

Preferred

• Certified Fraud Examiner (CFE)
• Accredited Healthcare Fraud Investigator (AHFI)
• Certified Professional reputed company (CPC)
• Certified in Healthcare Compliance (CHC)