Codoxo is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse in Healthcare which costs the nation $270B annually. Codoxo is rapidly growing and has won numerous awards. We are seeking exceptional talent to achieve our goal of ensuring that our scarce healthcare dollars go to real patient care.

Primary Responsibilities:

• Perform data analytics to identify fraud, waste or abuse in claims data
• Responsible for investigating, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices.
• Proactively identify instances of potential fraud, waste and abuse through data analysis using company system and tool
• Prepare statistical/financial analysis reports and graphic presentation for notification of findings
• Use knowledge of heath care coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies and relevant laws to find suspicious patterns in claims data and other sources
• Develop and maintain general knowledge healthcare reimbursement policies and state and federal regulations related to healthcare fraud and abuse
• Work cooperatively and constructively with team members, including mentoring, training and assisting team members as required
• Perform additional duties and projects as assigned by management
• Maintain security and confidentiality of all protected health information encountered in performance of duties

Required Qualifications:

• 1+ years of experience working in a healthcare Fraud Investigations role
• 1+ years of experience within the Health Insurance Claims Industry

Preferred Qualifications:

• Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar