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Medical Fraud Research Analyst
Not specifiedFull-timeBusiness IntelligenceHealthcare Technology
Investigate healthcare claims and billing patterns using a proprietary insights platform. Identify and validate potential fraud, anomalies, and payment inconsistencies, and present evidence-based findings to customers.
Responsibilities
- Investigate medical claims and billing patterns to identify potential fraud, anomalies, and payment inconsistencies
- Validate findings and distinguish meaningful anomalies from statistical noise, normal variation, and legitimate exceptions
- Expand individual findings into broader investigations, recurring patterns, and scalable detection concepts
- Research medical literature, public information, and other data sources
- Present evidence-based findings, supporting analysis, potential implications, and recommended next steps
- Share investigative insights and identify ways to improve platform detection capabilities
- Collaborate with analysts and medical experts on complex cases
Requirements
- Bachelor’s degree in medical sciences, life sciences, biology, neuroscience, bioinformatics, data science, or another analytical or research-oriented field
- At least 2 years of experience in intelligence research, analytical military service, fraud investigation, or similar investigative work
- Experience investigating anomalies, fraud, or unusual behavioral patterns in a data-driven sector
- Strong analytical thinking and problem-solving skills
- Curiosity and interest in research, investigation, and pattern discovery
- Ability to connect information, identify inconsistencies, and investigate beyond the obvious
- Ability to learn independently and work proactively
- Comfort with data, technology, and AI-powered tools
- Strong English reading and writing skills
Nice to have
- Academic or practical experience in medical or scientific research
- Familiarity with SQL, Python, Excel, or data analysis tools
- Interest in medicine, healthcare systems, or medical technologies
- Experience with US healthcare, medical billing, or insurance claims