Job Overview
Location
Remote USA
Job Type
Full-time
Category
Data Science
Date Posted
June 14, 2026
Full Job Description
đź“‹ Description
- • Analyze large datasets to identify patterns, trends, and anomalies indicative of healthcare fraud, waste, and abuse (FWA) using advanced analytical techniques and tools to generate investigative leads.
- • Collaborate with auditors and investigators to prepare detailed reports and provider education letters related to potential fraudulent activities.
- • Manage the preparation and submission of quarterly CMS fraud reports and regulatory memos to assess Devoted Health’s exposure or risk related to FWA.
- • Intake and triage referrals for fraud, waste, and abuse from both internal and external sources, prioritizing cases based on risk and evidence.
- • Develop comprehensive analytical reports summarizing findings, emerging trends, and actionable recommendations for targeted audits and investigations.
- • Partner with internal departments including Payment Integrity, Claims, and Clinical Escalations to share insights, align on FWA detection criteria, and coordinate cross-functional response strategies.
- • Create and distribute educational materials for internal staff, external providers, and members to raise awareness of fraud prevention and compliance expectations.
- • Conduct quality assurance reviews of case documentation to ensure accuracy, completeness, and adherence to regulatory and internal standards.
- • Attend and actively participate in weekly, bi-weekly, quarterly, and ad-hoc SIU and Payment Integrity status meetings to provide updates and coordinate investigative efforts.
- • Maintain current knowledge of federal and state healthcare regulations, including Medicare and Medicaid rules, and apply this knowledge to enhance compliance and fraud detection protocols.
- • Utilize data platforms such as Looker, Tableau, Power BI, SQL, or Qlik Sense to extract, visualize, and analyze healthcare claims data for fraud detection purposes.
- • Leverage Generative AI tools to automate routine investigative tasks, reduce manual review times for complex claim histories, and uncover hidden fraud indicators across high-volume datasets.
🎯 Requirements
- • Bachelor’s degree in business, healthcare administration, criminal justice, or a related field
- • Minimum of 3 years of experience in healthcare fraud investigation, medical claims analysis, or a related field
- • Proficiency in data analysis tools such as Excel/Google Sheets and knowledge of statistical analysis techniques
- • Strong analytical and problem-solving skills with the ability to interpret complex data and derive actionable insights
- • Excellent verbal and written communication skills for presenting findings to diverse audiences
- • High level of attention to detail and accuracy in data analysis and reporting
🏖️ Benefits
- • Employer-sponsored health, dental, and vision plans with low or no premium
- • Generous paid time off
- • $100 monthly mobile or internet stipend
- • Stock options for all employees
- • Bonus eligibility for all roles excluding Director and above
- • 401K program and parental leave program
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Devoted Health, Inc.
Devoted Health, Inc. operates as a Medicare Advantage health plan provider, offering comprehensive coverage, personalized care navigation, and integrated technology to seniors across the United States. The company combines clinical expertise, data analytics, and member support services to coordinate physician visits, prescription management, and preventive care, aiming to improve health outcomes and reduce unnecessary costs for its members.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
dbt Labs Inc.
4 months ago
Reddit Inc.
1 month ago
5 days ago
Trashie Inc.
8 months ago