Healthcare Fraud Shield

Analyst

• Use knowledge of Fraud, Waste and Abuse (FWA) to research, test and identify effective alerts and algorithms targeting FWA detection and prevention on claims
• Proactively analyzes and tests output of FWA schemes and enhancements to existing FWA schemes
• Understanding of pharmacy and medical claims data analysis and quality monitoring
• Maintain alert and policy knowledgebase
• Research supporting documentation for knowledgebases by client
• Execute test cases and analyze results
• Demonstrated aptitude for problem solving and debugging
• Identify and troubleshoot issues discovered during testing and reported by customers
• Work with cross-functional teams to ensure quality throughout the software development lifecycle
• Satisfies all applicable requirements imposed by applicable Company customers, clients, or business partners, with respect to the relationship and role
• Understands and complies with all company Privacy and Security standards
• Other duties as assigned

FWA Analyst Intern

Data Scientist

• - Provide technical contributions in a fast-paced R&D team environment to accelerate our efforts on building new analytics.
• - Utilize advanced mathematical models, machine learning algorithms, operations research techniques, and strong business acumen to deliver insight, recommendations, and solutions.
• - Analyze data sets and develop models to predict fraud, waste, and abuse.
• - Document and present results to internal team members for development and inclusion in company products and analysis.
• - Satisfies all applicable requirements imposed by applicable Company customers, clients, or business partners, with respect to the relationship and role.
• - Understands and complies with all company Privacy and Security standards.
• - This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.