SIU & Payment Integrity AI Analyst

Of the $3.8T we spend on healthcare in the United States annually, about a fourth of it is estimated to be partly lost due to waste, fraud, abuse, and errors. Codoxo is the premier provider of artificial intelligence–driven solutions that help healthcare companies and government agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity (PI).

We are purpose-driven with the goal of making healthcare more affordable and accessible to all. If you are passionate about improving healthcare through the combination of domain expertise and advanced technology, Codoxo is where you belong. We are venture-backed by leading investors, financially strong, and one of the fastest-growing healthcare AI companies in the industry.

Position Summary

Codoxo is seeking a full-time Payment Integrity Data Curator to support the development and refinement of Codoxo’s AI-driven payment integrity products by expanding and curating high-quality datasets used to measure and improve AI performance. This is a temporary 6-month role with the possibility of converting into an in-house employee status, based on business needs and performance.

This is a specialized role designed for experienced payment integrity professionals who can translate operational investigation and audit expertise into structured datasets that support the next generation of healthcare AI tools.

The PI Data Curator will work closely with Codoxo’s AI, product, and customer success teams to curate datasets that represent real-world payment integrity scenarios and investigative workflows across medical and pharmacy domains.

Core Objectives

1. Ground Truth Expansion

Expanding the curated ground truth dataset of SIU cases and claims used to measure the performance of Codoxo AI detection models and support continuous product development and improvements.

2. GenAI Investigator Workflow Feedback

Providing detailed feedback on how Codoxo’s GenAI tools interpret medical records and investigation artifacts, ensuring that the insights generated are useful for real-world payment integrity investigators and auditors.

3. Synthetic Healthcare Data Curation

Reviewing and curating synthetic datasets generated by AI and data engineering teams to ensure they accurately reflect real-world healthcare claims, medical records, and diagnostic imaging clinical scenarios.

Key Responsibilities

Review historical payment integrity/SIU cases and claims data to expand Codoxo’s curated ground truth datasets.
Identify and document confirmed fraud, waste, abuse, and payment error scenarios.
Annotate claims and investigation outcomes to support AI model training and benchmarking.
Ensure curated cases reflect real-world investigative findings and payer workflows.
Review outputs generated by Codoxo’s GenAI tools when analyzing medical records and investigation artifacts.
Provide structured feedback on whether generated insights reflect meaningful investigator workflows.
Review synthetic datasets created by Codoxo AI and data engineering teams.
Validate the realism of synthetic claims data, medical records, and diagnostic images.
Contribute to internal documentation and dataset curation guidelines that support ongoing AI product development.
Proactively identify new areas where data analysis can maximize product improvements with minimal effort, and maximal positive impact

Qualifications

CPC (Certified Professional Coder), CFE, AHFI or equivalent credential required.
Minimum 5 years of experience in SIU/investigations, healthcare payment integrity, and auditing.
Must have expertise in core coding and billing, fraud waste and abuse, and 2+ of the three areas below:
Professional Claims
Facility Claims
Experience reviewing medical records for coding discrepancies
High-value differentiators: DRG/APR-DRG auditing (MS-DRG/APR-DRG assignment validation, upcoding/DRG creep, LOS & medical necessity review); experience with medical necessity triggers, high-cost drug/services, pharmacy & DME integrity, behavioral health and Psychotherapy coding.
Proven track record in identifying overpayments, waste, and abuse through claims analytics or audit experience; preferably in a leading or consulting role.
Strong understanding of payer systems, coding, and reimbursement methodologies (CPT, HCPCS, ICD-10) specific to each Medicare, Medicaid, and commercial payer policies and claims systems.
Ability to communicate complex findings clearly and succinctly to both technical and non-technical teams.
Comfortable providing clear feedback and validation on an ongoing, project-based schedule in a fast-paced environment.
Nice to have: proven innovation record and systems-approach mindset, demonstrating ability to identify and drive process or product improvements.

About the Role

This role is ideal for a seasoned healthcare payment integrity professional who wants to help shape the future of AI-driven payment integrity solutions. By curating real-world datasets and validating synthetic healthcare data, the PI Data Curator will play a critical role in ensuring that Codoxo’s AI products reflect real investigative workflows and deliver meaningful insights to payment integrity teams.

The work performed in this role directly contributes to the continued improvement of Codoxo’s AI technology and its ability to help healthcare organizations detect fraud, waste, abuse, and payment errors more effectively.

Apply for this job

First name

Last name

Email address

Location

Phone number

Resume

Attach resume

Attach another file

Attach file

What is your Linkedin Profile URL?

What are your salary requirements?

What is your earliest start date?

We invite you to complete the optional self-identification questions below used for compliance with government regulations and record-keeping guidelines. Any self-identification information provided will not be considered in the selection process.

GENDER

VETERAN STATUS Learn more about veteran statuses

If you believe you belong to any of the categories of protected veterans listed below, please indicate by selecting the appropriate category(ies). The hiring employer is subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA) and requests this information in order to measure the effectiveness of the outreach and positive recruitment efforts it undertakes pursuant to VEVRAA.

DISABILITY STATUS Learn more about disability statuses

We are required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.