Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse.
Deliver monthly, prequalified FWA lead referral reports on a consistent and reliable cadence.
Produce reports that clearly articulate the analytic rationale, suspected behavior, and investigative relevance of each lead.
Ensure all outputs are defensible, audit-ready, and written for non-technical investigative and policy audiences.
Present FWA lead referrals to state Medicaid program integrity and OIG staff.
Explain findings, methodologies, and data sources in support of state investigations.
Respond to follow-up questions and perform supplemental or ad hoc analyses related to specific referrals.
Support investigations through documentation, exhibits, and data interpretation.
Participate in meetings, briefings, and, as needed, provide testimony or in-person investigative support (travel may be required).

Extensive experience analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse. (5+ years)
Deep knowledge of Medicaid program integrity, including common FWA schemes, audit methodologies, and investigative workflows. (5+ years)
Prepare reports and presentations documenting analytic methods and results for internal and external customers (4+ years)
Experience reading, interpreting, and applying Medicaid policy, regulations, state plan language, and related guidance.
Strong written and verbal communication skills, with experience presenting analytic findings to state agencies, Offices of Inspector General, or other oversight bodies.
Prior experience working directly with state Medicaid agencies and/or Offices of Inspector General is strongly preferred.
Professional certifications such as Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), and/or Accredited Health Care Fraud Investigator (AHFI) are preferred.

Senior Analyst, Payment Integrity Analytics

Key skills