Bluespine-Sr. FWA Analyst
Core
Identify fraud, waste, and abuse in medical billing claims for commercial payers using data analysis and domain expertise.
Role type
Sr. FWA Analyst (Fraud, Waste, and Abuse) (via careerplan.io/jobs/61-003-1F-F48-bluespine-sr-fwa-analyst)
Builds
Anomaly detection algorithms and audit frameworks for medical claims
Domain
Health-IT / Medical Billing / Insurance Fraud
Deliverable
production ML models
Required skills
SQL, graph-based tools, medical terminology, medical coding (CPT/HCPCS), DRG methodologies, claims adjudication processes, regulatory policy knowledge (CMS/HCFA), SIU/Payment Integrity experience
Preferred skills
Medical/clinical background, Pharma claims experience, billing/coding experience
Responsibilities
Proactively identify fraud, waste, and abuse instances through data analysis; Support engineering and data science teams with audit concepts and data mapping; Determine likelihood of true error/fraud based on real-life experience; Validate and tune anomaly detection algorithms
