Senior Compliance Analyst, Special Investigations Unit

Devoted Health

Senior Compliance Analyst supporting the detection of healthcare fraud within a remote USA health plan. Involves data analysis, collaboration with investigators, and compliance efforts.

Posted 6/12/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $58,000 - $90,000 per yearWebsite

About the role

Key responsibilities & impact

Analyze large datasets to identify patterns, trends, and anomalies indicative of fraudulent activity utilizing advanced analytical techniques and tools to support development of investigative leads.
Collaborate with auditors and investigators to prepare reports and provider education letters.
Manage quarterly CMS fraud reports and regulatory memos to determine if Devoted has any FWA exposure/ or risk.
Intaking and triaging referrals related to fraud, waste, and abuse, inclusive of internal and external referrals.
Develop comprehensive reports summarizing analyses and trends with recommendations for targeted audits and investigations.
Work closely with internal departments (e.g.,Payment Integrity, Claims, Clinical Escalations) to share findings and coordinate on concept development and FWA scheme targeting criteria.
Develop educational materials for internal and external stakeholders (e.g., providers, members, employees).
Conduct quality assurance (QA) review of case documentation.
Attend and participate in SIU and PI status meetings (weekly, bi-weekly, quarterly, ad-hoc).
Stay updated on relevant laws, regulations, and industry standards related to healthcare fraud and contribute to compliance efforts.

Requirements

What you’ll need

Bachelor’s degree in business, healthcare administration, criminal justice, or a related field.
Minimum of 3 years of experience in healthcare fraud investigation, medical claims analysis, or a related field.
Proficiency in data analysis tools (e.g.,Excel/Google Sheets) and knowledge of statistical analysis techniques.
Strong analytical and problem-solving skills, with the ability to interpret complex data and draw actionable insights.
Excellent verbal and written communication skills, with the ability to present findings clearly to diverse audiences.
High level of attention to detail and accuracy in data analysis and reporting.

Benefits

Comp & perks

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....

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Hard Skills & Tools

data analysisstatistical analysisfraud investigationmedical claims analysisreport writingquality assurance

Soft Skills

analytical skillsproblem-solving skillscommunication skillsattention to detail