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Fraud Analyst / Healthcare Domain

DVI Technologies, Inc.

Remote • Today

Easy Apply

Contract

$40 - $50

Senior SIU Analyst / Fraud Analyst / Healthcare Domain Only

DVI Technologies, Inc.

Remote • Today

Easy Apply

Contract

45 - 50

Delphi Developer

DVI Technologies, Inc.

Remote • Today

Easy Apply

Contract

Depends on Experience

Delphi Developer

DVI Technologies, Inc.

Remote • 7d ago

Easy Apply

Contract

Depends on Experience

Job Details

Skills

CPT/HCPCS
ICD-10
DRG/APC
AHFI
CFE
CPC/CPMA
SQL
NCCI edits
FWA

Summary

Summary:

Validate whether the FWA detection approach surfaces real, actionable fraud/waste/abuse signal, and produce substantiated findings to support FWA product development.

Responsibilities:

Review claims flagged by detection logic and determine true positive vs. false positive
Articulate the specific billing pattern, code combination, or provider behavior driving each call
Carry select flagged leads through to a documented, substantiated finding
Partner with product and data science teams to translate investigative judgment into refined detection rules
Track progress against substantiation-rate and findings-volume targets (set once POC window and initial data are confirmed)
Write a findings/recommendation memo scale, iterate, or kill for internal stakeholders
Present findings clearly to non-investigator audiences (product, compliance, leadership)

Skills & Qualifications:

4+ years FWA investigative experience, payer-side preferred
Direct exposure to claims coding logic (CPT/HCPCS, ICD-10, DRG/APC)
Must have prior experience starting cold on a live data feed
Comfortable working from partial/imperfect data sample extracts, not a finished production system
Certification required: AHFI, CFE, or CPC/CPMA
SQL or equivalent self-serve query ability
Familiarity with edit/rules logic (e.g., NCCI edits)

Education:

Bachelor's degree, or 7+ years relevant experience in lieu

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10180535
Position Id: 9112503
Posted 1 day ago

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Contact the job poster

Gulshan Sharnagat

Recruiter @ DVI Technologies, Inc.

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Remote

•

Today

The Senior SIU Analyst - FWA Detection is a highly analytical role focused on identifying and mitigating Fraud, Waste, and Abuse (FWA) as a leading provider of cloud-based healthcare software. Core Responsibilities Data-Driven Detection: Analyze healthcare claims data, dashboards, and predictive models to uncover anomalies, atypical billing patterns, and emerging fraud trends.Investigation Management: Lead complex, multi-layered investigations from inception through resolution, including overpay

Easy Apply

Contract

45 - 50

Certified Medical Coder/Auditor

Remote

•

16d ago

Certified Medical Coder/Medical Record Audit Specialist - Behavioral HealthLocation: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)Job Summary:We are seeking aCertified Medical Coder/Medical Record Audit Specialistwith strongBehavioral Healthcoding experience to support a state Medicaid program engagement. This role focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issues, a

Easy Apply

Contract

Depends on Experience

Healthcare Claims Data Analyst

Remote

•

Today

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: None Job Family: Data Science and Data Engineering Job Qualifications: Skills: Data Analytics, Health Care, Python for Data Analysis, Statistical Analysis Certifications: None Experience: 4 + years of related experience ship Required: No Job Description: At GDIT, people are our differentiator. Our work depends on a Data Analyst joining our te

Full-time

USD 76,500.00 - 103,500.00 per year

Healthcare Claims Tester

Remote

•

Yesterday

Position: Healthcare Claims Tester Location: Remote Project description You will be part of a team responsible for testing healthcare claims processing, benefits, pricing, and related workflows for a non-profit healthcare organization in the US. The role is focused on validating local claims processing within HealthRules Payer (HRP), including EDI transactions, Blue Card claims, and HRP-to-TPA workflows. You will collaborate closely with Product Owners, Business Analysts, Developers, and QA team

Easy Apply

Contract

$60 - $65