Senior FWA Analyst (Healthcare)

TL;DR

Senior FWA Analyst (Healthcare): Identifying billing anomalies, improper payments, and potential fraud in Medicaid home and community-based care datasets with an accent on SQL-based analytical logic and forensic data investigations. Focus on building scalable detection tools, collaborating with engineering to integrate AI-driven fraud identification, and ensuring program integrity for state and managed care clients.

Location: Must be based in the United States (preference for New York City, Washington DC/Baltimore, Minneapolis/St. Paul, or Philadelphia metro areas). Role requires up to 10% travel.

Salary: $120,000–$140,000

Company

hirify.global is a leading technology platform providing end-to-end homecare solutions that connect patients, providers, and managed care organizations to improve healthcare delivery.

What you will do

• Analyze large Medicaid claims and billing datasets to detect fraud, waste, and abuse patterns.
• Develop and refine SQL-based analytical queries to identify billing inconsistencies and anomalies.
• Translate complex analytical findings into actionable product requirements for engineering teams.
• Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows.
• Test and validate new automated detection tools and AI-driven models.
• Present insights and findings to internal stakeholders and payer clients.

Requirements

• 3–7 years of experience in healthcare analytics, payment integrity, or fraud detection.
• Strong proficiency in SQL for querying and analyzing large datasets.
• Working knowledge of Medicaid or healthcare billing structures.
• Experience identifying patterns and outliers in healthcare claims or billing data.
• Strong investigative and analytical problem-solving skills.
• Experience using AI or machine learning tools for anomaly detection or predictive analytics in healthcare.

Nice to have

• Experience with Python or R.
• Knowledge of electronic visit verification (EVV) data.
• Professional certifications such as CFE, AHFI, CPC, or CHC.
• Background working with managed care plans or healthcare analytics companies.

Culture & Benefits

• Competitive health plans and comprehensive benefits package.
• 401K retirement program with company-matched contributions.
• Paid time-off and company-paid holidays.
• Opportunity to work on impactful technology in the homecare and Medicaid space.