FWA Analyst Intern

🕒 May 14

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Healthcare Fraud Shield

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

💰 Private Equity Round on 2021-01

Healthcare Insurance • Artificial Intelligence • Fraud Prevention

Healthcare Fraud Shield is a company specializing in Payment Integrity and Cost Containment solutions for healthcare insurers. They offer a comprehensive, AI-driven platform that incorporates advanced anomaly detection and a proprietary data fusion library to combat fraud, waste, abuse, and errors in healthcare claims. Their robust end-to-end solution optimizes the auditing process, utilizing both pre- and post-payment data to maximize savings and improve accuracy in claim processing. By providing actionable insights and expert support, Healthcare Fraud Shield helps organizations achieve significant annual savings and enhance operational efficiency.

📋 Description

• 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

🎯 Requirements

• Knowledge of healthcare Fraud, Waste and Abuse (FWA) • Knowledge of health care, insurance, medical terminology, CPT, HCPCS, DRG, Revenue, ICD-10 • Ability to document and troubleshoot errors • Excellent communication skills both verbally and written • Attention to detail • Analytical mind and problem-solving aptitude • Excellent troubleshooting and problem solving skills • Ability to communicate instructions in a clear and concise manner • Comfortable multitasking in fast paced environment • Able to work independently as well as part of a dynamic team • Strong communication and listening skills • Strong analytical skills • Strong computer skills • Detail oriented

🏖️ Benefits

• - Medical, Dental & Vision insurance • - 401(k) retirement savings with employer match • - Vacation and sick paid time off • - 8 paid holidays • - Paid maternity/paternity leave • - Disability & Life insurance • - Flexible Spending Account (FSA) • - Employee Assistance Program (EAP) • - Professional and career development initiatives • - Remote work eligible