Jobs → Data & Analytics → Investigations and Fraud, Waste & Abuse Analyst

About the Role We are seeking an Investigations and Fraud, Waste & Abuse Analyst to join our team. This role involves reviewing claims flagged by detection logic and determining true positive vs. false positive cases. Key Responsibilities • Review claims flagged by detection logic and determine true positive vs. false positive • Articulate the specific billing pattern, code combination, or provider behavior driving each call • Carry select flagged leads through to a documented, substantiated finding • Partner with product and data science teams to translate investigative judgment into refined detection rules • Track progress against substantiation-rate and findings-volume targets Requirements • CPC/CPMA certification required • Experience with Fraud, Waste, and Abuse • Commercial Medicare/Medicaid experience • SQL experience • Experience with Health plans • On-site work in Bowie, MD 3 days a week