Bluespine- Medical Fraud & Anomaly
Core
Investigate healthcare claims, identify unusual billing patterns, and uncover potential fraud and payment anomalies using Bluespine's proprietary Insights Platform.
Role type
Senior IC medical fraud investigator (data-driven)
Builds
Scalable detection concepts and evidence-based findings for healthcare customers
Domain
Healthcare + Fraud Detection + Data Analysis
Deliverable
production ML models
Required skills
Analytical thinking, problem-solving, pattern recognition, independent research, data analysis, evidence synthesis, cross-functional collaboration
Preferred skills
SQL, Python, Excel, medical/scientific research experience, US healthcare billing knowledge
Technologies
Bluespine Insights Platform, AI-powered tools
Responsibilities
Investigate medical claims and analyze billing patterns; Validate findings to distinguish anomalies from noise; Expand investigations into broader patterns; Conduct independent research using medical literature and data sources; Present evidence-based findings and recommendations; Contribute to improving detection capabilities; Collaborate with analysts and medical experts
Seniority
Senior, hands-on IC
