{"schemaVersion":"jobsearcher.job.v1","id":"4a128802b691751271a9f4c6","url":"https://jobsearcher.com/jobs/4a128802b691751271a9f4c6","canonicalUrl":"https://jobsearcher.com/jobs/4a128802b691751271a9f4c6","title":"Data Analyst","description":"SR FWA Data AnalystOur client is a leading national administrator of federal health benefit programs (FEHB, PSHB, and FEDVIP) currently building out an enhanced enterprise FWA function. As the analytics backbone of this new program, the FWA Data Analytics Lead will design and operate the client's independent fraud detection and monitoring capability across a large, complex federal claims population.This is a rare opportunity to build a fraud analytics function from the ground up — designing the fraud scoring models, provider monitoring dashboards, and typology surveillance that will become the \"eyes\" of a regulator-facing FWA program.Key ResponsibilitiesFraud Detection & AnalyticsDesign, build, and maintain fraud scoring models across provider, member, and subcontractor fraud typologiesDevelop the FWA Reporting, Monitoring & Typology Dashboard portfolio for executive and regulator consumptionPerform proactive anomaly detection, geographic trending, provider peer group analysis, and case aging analyticsSupport pre-payment and post-payment analytics including COB, duplicate claims, and coding pattern analysisDevelop and Monitor FWA Analytic Work PlanChair the FWA Analytic Data Intelligence Committee (Subcommittee of the FWA Committee)Subcontractor Analytic OversightBuild independent, client-side analytics to validate — not simply consume — the TPA SIU's fraud detection outputPartner with the TPA analytics team on joint case identification and reconciliationFeed data into regulator-facing templates including the OPM FWA Computer Code template and quarterly ROI reportingProgram SupportOwn exclusion monitoring across LEIE, SAM, and applicable state exclusion databasesSupport dental FEDVIP pre-determination analytics and dual-enrollment COB scenariosProduce data packages for OPM site visit questionnaires, CAPs, and OPM-OIG referralsRequired Qualifications5+ years of FWA and/or Payment Integrity analytic vendor experience5+ years of health plan fraud analytics experience; FEHB, PSHB, FEDVIP, Medicare Advantage, or Medicaid Managed Care, Commercial Healthcare, ORAdvanced Data Management Tools, erwin Data Intelligence Suite, Atlan Data CatalogAdvanced Storage and Platforms, Snowflake Data Cloud, Microsoft Fabric, Azure Synapse Analytics, and Microsoft AzureAdvanced Analytics Tools, SQL, Python, R, Power BI, and SaSAdvanced Machine Learning, Python, R, PySpark, Jpyter Notebooks, Streamlit, and MLflowAdvanced AI and Copilot Solutions, Microsoft Copilot, GitHub Copilot, Snowflake Cortex (CoCo), Azure AI, Azure OpenAI, and MLflowAdvanced to Expert Dashboard Development, Power BI, Tableau and ExcelWorking knowledge of CPT, HCPCS, ICD-10, DRG, and dental (CDT) coding structuresExperience with claims data at scale (millions of claims per year)Bachelor's degree in a quantitative discipline (Statistics, Data Science, Actuarial Science, Health Informatics, Computer Science, or equivalent)Preferred QualificationsCertified Fraud Examiner (CFE), Certified Health Insurance Analyst (CHIA), or Accredited Health Care Fraud Investigator (AHFI)Direct experience with UMR CPS, Facets, or QNXT claims platformsFamiliarity with SAS Fraud Framework, Shift Technology, Codoxo, or Cotiviti Payment IntegrityPrior support of OPM, OPM-OIG, HHS-OIG, or DOJ data requestsMaster's degree in a quantitative or health data discipline","company":"Advantage Tech","rawCompany":"advantage tech","city":"Denver","state":"CO","isRemote":false,"isActive":false,"createdAt":"2026-09-15T12:45:07.540Z","occupations":[{"code":"15-1243.01","title":"Data Warehousing Specialists","slug":"data-warehousing-specialists"},{"code":"15-2051.00","title":"Data Scientists","slug":"data-scientists"},{"code":"15-2051.02","title":"Clinical Data Managers","slug":"clinical-data-managers"}],"industries":[{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"},{"code":"541690","title":"Other Scientific and Technical Consulting Services","slug":"other-scientific-and-technical-consulting-services"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Data Analyst","description":"SR FWA Data AnalystOur client is a leading national administrator of federal health benefit programs (FEHB, PSHB, and FEDVIP) currently building out an enhanced enterprise FWA function. As the analytics backbone of this new program, the FWA Data Analytics Lead will design and operate the client's independent fraud detection and monitoring capability across a large, complex federal claims population.This is a rare opportunity to build a fraud analytics function from the ground up — designing the fraud scoring models, provider monitoring dashboards, and typology surveillance that will become the \"eyes\" of a regulator-facing FWA program.Key ResponsibilitiesFraud Detection & AnalyticsDesign, build, and maintain fraud scoring models across provider, member, and subcontractor fraud typologiesDevelop the FWA Reporting, Monitoring & Typology Dashboard portfolio for executive and regulator consumptionPerform proactive anomaly detection, geographic trending, provider peer group analysis, and case aging analyticsSupport pre-payment and post-payment analytics including COB, duplicate claims, and coding pattern analysisDevelop and Monitor FWA Analytic Work PlanChair the FWA Analytic Data Intelligence Committee (Subcommittee of the FWA Committee)Subcontractor Analytic OversightBuild independent, client-side analytics to validate — not simply consume — the TPA SIU's fraud detection outputPartner with the TPA analytics team on joint case identification and reconciliationFeed data into regulator-facing templates including the OPM FWA Computer Code template and quarterly ROI reportingProgram SupportOwn exclusion monitoring across LEIE, SAM, and applicable state exclusion databasesSupport dental FEDVIP pre-determination analytics and dual-enrollment COB scenariosProduce data packages for OPM site visit questionnaires, CAPs, and OPM-OIG referralsRequired Qualifications5+ years of FWA and/or Payment Integrity analytic vendor experience5+ years of health plan fraud analytics experience; FEHB, PSHB, FEDVIP, Medicare Advantage, or Medicaid Managed Care, Commercial Healthcare, ORAdvanced Data Management Tools, erwin Data Intelligence Suite, Atlan Data CatalogAdvanced Storage and Platforms, Snowflake Data Cloud, Microsoft Fabric, Azure Synapse Analytics, and Microsoft AzureAdvanced Analytics Tools, SQL, Python, R, Power BI, and SaSAdvanced Machine Learning, Python, R, PySpark, Jpyter Notebooks, Streamlit, and MLflowAdvanced AI and Copilot Solutions, Microsoft Copilot, GitHub Copilot, Snowflake Cortex (CoCo), Azure AI, Azure OpenAI, and MLflowAdvanced to Expert Dashboard Development, Power BI, Tableau and ExcelWorking knowledge of CPT, HCPCS, ICD-10, DRG, and dental (CDT) coding structuresExperience with claims data at scale (millions of claims per year)Bachelor's degree in a quantitative discipline (Statistics, Data Science, Actuarial Science, Health Informatics, Computer Science, or equivalent)Preferred QualificationsCertified Fraud Examiner (CFE), Certified Health Insurance Analyst (CHIA), or Accredited Health Care Fraud Investigator (AHFI)Direct experience with UMR CPS, Facets, or QNXT claims platformsFamiliarity with SAS Fraud Framework, Shift Technology, Codoxo, or Cotiviti Payment IntegrityPrior support of OPM, OPM-OIG, HHS-OIG, or DOJ data requestsMaster's degree in a quantitative or health data discipline","datePosted":"2026-09-15T12:45:07.540Z","dateModified":"2026-09-15T12:45:07.540Z","hiringOrganization":{"@type":"Organization","name":"Advantage Tech","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Denver","addressRegion":"CO","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"4a128802b691751271a9f4c6"},"url":"https://jobsearcher.com/jobs/4a128802b691751271a9f4c6"}}