FWA Payment Integrity Data Analyst III (Health Plan & SQL exp required)

Role overview This analyst leads data investigations that help identify and reduce fraud, waste, abuse, and payment errors in healthcare programs. The work combines advanced analysis, research into billing and policy rules, and collaboration with internal teams and external program integrity partners to guide decisions and measure results.

Responsibilities - Develop analytic approaches and investigate data across healthcare lines of business to surface risks, trends, and potential patterns of improper payment. - Review vendor analyses and deliverables, clarify findings, and recommend solutions aligned with program goals. - Examine claims, coding rules, policies, and regulations to test hypotheses and explain complex data relationships. - Measure the impact of initiatives using statistical analysis, sampling, and hypothesis testing; prepare clear findings and visual summaries for management and audit use. - Support investigations and legal proceedings with data, analysis, and timely claims processing; monitor emerging vulnerabilities and recommend ways to reduce risk.

Requirements - Bachelor’s degree or equivalent relevant experience, plus at least seven years in data analysis, fraud, waste, and abuse analytics or analytic programming. - At least seven years of healthcare delivery or payer experience, including three years working with Medicare or Medicaid. - Extensive experience writing SQL queries and using data visualization or dashboard tools such as Power BI. - Knowledge of database design and integration, healthcare billing rules, and procedure and diagnosis coding, including CPT, ICD-10, HCPCS, APC, or DRGs. - Strong analytical judgment, documentation, communication, and presentation skills; able to lead analytic work independently and with a team.

Nice to have - Clinical experience or a coding credential from AAPC or AHIMA. - Familiarity with Python or Visual Basic, SAS, Microsoft SQL Server, SSIS, and inferential or descriptive statistics.

Benefits and work setup The role is based in a general office environment and may involve extended periods sitting or standing. Travel is not typically required. The listing describes a salary range of $83,000–$132,800 and possible performance-based bonus eligibility.