Sr. Fraud, Waste, And Abuse Data Analyst (Healthcare)

TL;DR

Sr. Fraud, Waste, and Abuse Data Analyst (Healthcare): Analyzing Medicaid claims and billing datasets to identify suspicious patterns and anomalies with an accent on developing scalable detection tools and AI-driven fraud identification capabilities. Focus on translating analytical findings into actionable requirements for product and engineering teams, supporting client discussions, and advising payer and state partners on detection methodologies.

Location: This is a fully remote opportunity for candidates located in the EST or CST time zones within the US only.

Salary: $130,000-155,000/yr, not including variable compensation.

Company

HHAeXchange is the leading technology platform for home and community-based care, supporting Medicaid home and community-based care (HCBS) programs across all 50 states.

What you will do

• Analyze Medicaid claims, visit, and billing datasets using SQL and other analytical tools to identify patterns and anomalies indicative of 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.
• Translate analytical findings into clear, actionable requirements for product and engineering teams.
• Present analytical findings and insights to internal stakeholders and payer clients in a clear and actionable format.
• Advise payer and state partners on detection methodologies aligned with CMS program integrity expectations and applicable federal regulations.

Requirements

• 5–7 years of experience in healthcare analytics, payment integrity, fraud detection, program integrity, forensic data analysis, or a related field.
• Strong SQL proficiency, including the ability to independently query and analyze large, complex datasets.
• Experience using AI or machine learning tools for anomaly detection, fraud identification, risk scoring, or predictive analytics in healthcare claims data.
• Solid understanding of the end-to-end revenue cycle, including claims submission, adjudication, and denial/appeal processes.
• Working knowledge of Medicaid billing structures and federal Medicaid program integrity regulations.
• This is a fully remote opportunity for candidates located in the EST or CST time zones within the US only.

Nice to have

• Experience with a payment integrity organization, healthcare analytics company, managed care plan, or state Medicaid agency.
• Experience with Python, R, or advanced analytics and data visualization tools.
• Experience with electronic visit verification (EVV) data and familiarity with EVV mandates under the 21st Century Cures Act.
• Professional certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or Certified Professional Coder (CPC).

Culture & Benefits

• Competitive health plans, paid time-off, and company-paid holidays.
• 401K retirement program with a Company-elected match.
• Equal-opportunity employer.