Senior SIU Analyst / Healthcare Domain Only

Hybrid in Bowie, MD, US • Posted 43 minutes ago • Updated 43 minutes ago
Contract W2
Contract Independent
6 Months
No Travel Required
Hybrid
$40 - $45/hr
Fitment

Dice Job Match Score™

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Job Details

Skills

  • healthcare fraud investigations
  • healthcare data analytics
  • medical claims auditing
  • HIPAA
  • data privacy
  • SQL
  • Excel
  • advanced visualization platforms
  • Criminal Justice
  • Law Enforcement

Summary

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.

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: 9107447
  • Posted 43 minutes ago
Contact the job poster
Gulshan Sharnagat

Gulshan Sharnagat

Recruiter @ DVI Technologies, Inc.
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