The Quality Assurance Analyst performs data validation and analytical reviews of Medicaid payment integrity activities to ensure accurate and defensible results. They conduct detailed claims-level analysis to identify billing patterns, utilization anomalies, and potential overpayment scenarios.
Lead the architecture and evolution of production AI platforms spanning Machine Learning, Generative AI, and Agentic AI. Provide technical leadership and people management to AI engineers while partnering with Product and Security to deliver scalable SaaS solutions.
Lead transformation-focused sales engagements with national healthcare payers to drive sustainable cost containment. Architect long-term customer journeys and structure complex commercial partnerships in collaboration with executive leadership.
Analyze healthcare claims data to detect fraud, waste, and abuse while ensuring payment integrity. Collaborate with technical teams to optimize FWA detection software and conduct professional outreach to providers regarding coding practices.
Design, develop, and maintain scalable ETL/ELT data pipelines to support analytics and machine learning initiatives. Collaborate with data scientists and analysts to optimize database performance and ensure secure data delivery.
Design, develop, and maintain scalable ETL/ELT data pipelines to support analytics and machine learning initiatives. Collaborate with data scientists and analysts to optimize database performance and ensure secure data delivery.
Design and build AI-powered automations and internal productivity tools using LLMs and APIs. Collaborate with cross-functional teams to identify automation opportunities and integrate AI capabilities into existing business processes.
Design and operate agentic AI products to automate healthcare claim audits and SIU investigations. Build serverless architectures on AWS using Bedrock AgentCore and orchestrate multi-agent plans with Strands.
The role involves running AI analytical reports and managing automation scripts using AWS Airflow. Additionally, the engineer will monitor AWS infrastructure health and create data visualizations in AWS QuickSight.
Perform medical claim audits to identify overpayments by reviewing billing, coding policies, and regulatory requirements. Collaborate with AI teams to translate clinical and regulatory needs into audit models and deterministic logic.
The Client Implementation Director manages the planning, scoping, and delivery of AI solutions to healthcare clients to maximize value. This includes managing project risks, facilitating executive business reviews, and implementing process improvements.
The role acts as a bridge between customer success and product management to support Payment Integrity SaaS solutions and client adoption. Key duties include translating client needs into technical specifications, supporting data mining operations, and documenting product requirements.
Own the strategy, roadmap, and execution for an AI-powered Fraud, Waste, and Abuse detection platform. Lead the transition toward agentic AI workflows to automate lead triage and evidence gathering for healthcare investigators.
