Prevention & Control Specialist (Healthcare)

TL;DR

Prevention & Control Specialist (Healthcare): Protecting the integrity of a transportation benefit program by monitoring ride activity and analyzing data to detect fraud, waste, or abuse with an accent on data-driven detection and provider compliance. Focus on conducting proactive facility outreach, investigating suspicious activity via Jira, and leveraging QuickSight for trend reporting.

Location: Remote (Must be based in the US, San Antonio, Texas mentioned)

Company

hirify.global is a technology and services company reducing barriers to care by improving the delivery of non-emergency medical transportation via proprietary technology for Medicare and Medicaid programs.

What you will do

• Monitor ride activity to identify and investigate potential instances of fraud, waste, or abuse.
• Conduct outreach to healthcare facilities to verify ride accuracy and compliance.
• Investigate suspicious activity using the Jira fraud-tip system and escalate cases as needed.
• Analyze data and generate reports using Amazon QuickSight and Excel to detect emerging fraud patterns.
• Collaborate with internal teams to optimize recurring ride patterns and reduce service gaps.

Requirements

• Must be located in the United States
• High school diploma or equivalent.
• 1+ year of experience in customer service or healthcare operations.
• Familiarity with Medicaid/Medicare or general healthcare operations.
• Strong communication skills for conducting external partner outreach.
• Ability to travel approximately 10% of the time

Nice to have

• Proficiency in data entry and case documentation systems (QuickSight, Excel).
• Bilingual proficiency in English and Spanish.

Culture & Benefits

• Remote work flexibility.
• Mission-driven environment focused on equitable healthcare access.
• Opportunity to work with proprietary technology in the NEMT (non-emergency medical transportation) sector.