Fraud, Waste & Abuse Lead Analyst

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Fraud, Waste & Abuse Lead Analyst based in United States.

The Fraud, Waste & Abuse Lead Analyst will play a critical role in identifying, preventing, and reducing healthcare-related financial and operational risks through advanced analytics and data-driven strategies. This position combines analytical expertise, project leadership, and stakeholder collaboration to transform complex data into actionable insights. You will lead initiatives involving reporting, machine learning, AI-driven solutions, and risk trend analysis to strengthen fraud prevention capabilities. The role requires close partnership with business teams, data science professionals, and operational leaders to develop effective mitigation strategies. You will help shape best practices, improve analytics maturity, and influence strategic decisions through meaningful insights. This is an opportunity to make a measurable impact within a mission-driven healthcare environment focused on improving outcomes and protecting resources.

Accountabilities:: The Fraud, Waste & Abuse Lead Analyst is responsible for leading advanced analytics initiatives, reporting strategies, AI and machine learning projects, and data mining efforts to identify and mitigate fraud, waste, and abuse risks. This role serves as a subject matter expert who translates complex information into recommendations that support business decisions, operational improvements, and risk reduction.

Lead complex analytics, reporting, and data mining initiatives focused on identifying healthcare fraud, waste, and abuse risks.

Coordinate AI and machine learning projects designed to improve proactive risk detection and mitigation capabilities.

Analyze claims data, financial trends, and operational information to uncover patterns, risks, and opportunities for improvement.

Develop and maintain reporting solutions, dashboards, and analytical tools that support strategic decision-making.

Partner with business stakeholders, data science teams, and operational groups to translate insights into actionable strategies.

Review claims associated with fraud, waste, and abuse and provide recommendations to address identified risks.

Serve as a trusted advisor to leadership by communicating trends, findings, and mitigation opportunities.

Establish analytics best practices and contribute to improving reporting quality, consistency, and departmental maturity.

Lead cross-functional projects and workstreams while managing priorities with minimal supervision.

Apply independent judgment to evaluate complex issues, assess available options, and recommend effective solutions.

Requirements:

The ideal candidate is an experienced analytics professional with strong expertise in healthcare risk analysis, claims operations, and data-driven decision-making. You should have demonstrated experience leading analytical initiatives, collaborating with stakeholders, and communicating insights to senior audiences.

Bachelor’s degree in a related field or equivalent combination of education and experience.

8+ years of progressive experience in technical data analysis roles.

2+ years of experience leading projects, initiatives, or cross-functional workstreams.

2+ years of experience reviewing claims related to fraud, waste, and abuse.

Experience working with claims platforms and understanding claim processing operations.

Advanced proficiency with Microsoft Office applications, including Excel, Access, Word, and PowerPoint.

Strong analytical and problem-solving skills with the ability to interpret complex datasets.

Excellent written and verbal communication skills, including experience presenting recommendations to senior and executive leadership.

Ability to manage multiple priorities and operate effectively in a complex business environment.

Advanced proficiency with SQL, SAS, or other analytical and data management platforms is preferred.

Experience developing dashboards, visualizations, and reporting solutions using tools such as Power BI is preferred.

Master’s degree in Data Analytics, a quantitative discipline, or related field is preferred.

Professional certifications in analytics, project management, or related areas are a plus.

Benefits:

Competitive annual salary range of $104,000 - $143,000 , depending on location, skills, experience, education, and qualifications.

Eligibility for a bonus incentive plan based on individual and organizational performance.

Fully remote work opportunity across the United States.

Comprehensive medical, dental, and vision benefits.

401(k) retirement savings plan.

Paid time off, company holidays, and personal holidays.

Paid parental and caregiver leave programs.

Short-term and long-term disability coverage.

Life insurance and additional employee wellness benefits.

Supportive work environment focused on professional growth, collaboration, and meaningful impact.

Occasional travel opportunities for training, meetings, or team events.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1