Senior SIU Analyst / Healthcare Domain Only

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 overpayment recovery and calculating total savings.
• Regulatory Compliance: Maintain current knowledge of federal and state regulations, ensuring all findings align with healthcare legal compliance standards.
• Reporting & Collaboration: Compile investigative summaries and intelligence reports for senior leadership, clinical reviewers, and external law enforcement or regulatory entities.

Requirements

• 3 to 5+ years of experience in healthcare fraud investigations, healthcare data analytics, or medical claims auditing within a health plan or payer environment. 
• 1+ year of experience with applicable fraud statutes and regulations, and federal guidelines on recoupments and other anti-FWA activity
• Experience working in the healthcare domain across several product lines specifically with claims processing, billing, reimbursement, or provider contracting.
• Experience with HIPAA, data privacy, and/or data security processes
• Bachelor's degree in Criminal Justice or a related field
• Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), Certified Professional Coder (CPC), or similar

Skills 
Proficient in data literacy (SQL, Excel, or advanced visualization platforms) with strong critical-thinking skills to trace complex financial or clinical anomalies.