Senior Compliance Analyst (Healthcare)

TL;DR

Senior Compliance Analyst (Healthcare): Detecting and preventing fraudulent activities within a health plan with an accent on data analysis and regulatory compliance. Focus on analyzing large datasets to identify fraud, waste, and abuse patterns and developing strategies to mitigate risk.

Location: Remote (USA)

Salary: $58,000–$90,000 / year

Company

hirify.global is an integrated healthcare company focused on improving the health and well-being of older Americans by combining insurance, clinical care, and technology.

What you will do

• Analyze large datasets using advanced techniques to identify patterns and anomalies indicative of healthcare fraud.
• Manage quarterly CMS fraud reports and regulatory memos to evaluate FWA exposure and risk.
• Triage internal and external referrals related to fraud, waste, and abuse.
• Collaborate with internal departments like Payment Integrity and Claims to coordinate FWA scheme targeting.
• Develop comprehensive reports and educational materials for providers, members, and employees.
• Conduct quality assurance reviews of case documentation.

Requirements

• Bachelor’s degree in business, healthcare administration, criminal justice, or a related field.
• Minimum of 3 years of experience in healthcare fraud investigation or medical claims analysis.
• Proficiency in Excel/Google Sheets and knowledge of statistical analysis techniques.
• Strong analytical and problem-solving skills for interpreting complex data.
• Must be based in the USA.

Nice to have

• Experience in a health plan SIU or Medicare Advantage/Managed Care setting.
• Proficiency in data platforms such as SQL, Looker, Tableau, Power BI, or Qlik Sense.
• Experience using Generative AI tools to automate investigative tasks.
• Familiarity with Medicare and Medicaid regulations and healthcare claims processing.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Stock options for all employees and bonus eligibility.
• 401K program and parental leave.
• $100 monthly mobile or internet stipend.
• Generous paid time off.