Financial Analyst - Fraud, Waste and Abuse (FWA)

Doctors Healthcare Plans ‚Ä¢ Coral Gables, Florida ‚Ä¢ Full Time

Posted on Tue, Aug 4, 2026

Onsite PositionThe Financial Analyst - Fraud, Waste and Abuse (FWA) is responsible for identifying, investigating and preventing fraudulent, wasteful and abusive activities related to healthcare claims, insurance, government programs, or organizational operations. This role uses data analysis, investigative techniques, and regulatory knowledge to detect suspicious patterns, minimize financial losses and ensure compliance with applicable laws and company policies.
Key Responsibilities:
Reporting & Analytics Support

Analyze medical, pharmacy, provider, and member-level claims data to identify potential FWA, overutilization, unusual billing patterns
Perform data mining, auditing, trend analysis, outlier detection, and root-cause analysis across providers, members, CPT codes, diagnosis codes, DRG codes, and claim types.
Generate and prioritize investigative leads

Recovery and Payment Integrity Activities

Support pre-payment and post-payment review activities
Recommend enhancements to claim edit rules and controls to prevent future improper payments

Reporting and Monitoring

Document models, provide investigative summaries and recommendations for review by FWA, Finance, Compliance, Medical Management, and other leadership.
Produce FWA dashboard, and reports on savings and recoveries, trends and emerging risks, provider and member monitoring, etc.

Documentation

Support FWA program reporting, audit responses, policy/procedure development, and operational documentation

Other

Maintain confidentiality of sensitive information and investigative findings
Meet performance goals as established for the position
Perform additional duties and responsibilities as assigned by management

The above statement reflects the general duties considered necessary to describe the principal functions of the job identified and shall not be considered as a detailed description of all work requirement inherent to the position.
Qualifications:

Bachelor’s degree
Three-year experience in healthcare and/or Medicare Advantage plans
Experience with healthcare claims analysis, large data sets and claim analytics
Ability to manage multiple investigations simultaneously
Able to meet deadlines, multi-task and thrive in high-pressure environment
Excellent oral and written communication
Proficiency with MS office with advanced skills in Excel and SQL
Experience with PowerBI and developing dashboards
Ability to work independently and collaboratively in a team environment

No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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