Healthcare Fraud Shield

• Use knowledge of Fraud, Waste and Abuse (FWA) to research, test and identify effective alerts and algorithms targeting FWA detection and prevention on claims • Proactively analyzes and tests output of FWA schemes and enhancements to existing FWA schemes • Understanding of pharmacy and medical claims data analysis and quality monitoring • Maintain alert and policy knowledgebase • Research supporting documentation for knowledgebases by client • Execute test cases and analyze results • Demonstrated aptitude for problem solving and debugging • Identify and troubleshoot issues discovered during testing and reported by customers • Work with cross-functional teams to ensure quality throughout the software development lifecycle • Satisfies all applicable requirements imposed by applicable Company customers, clients, or business partners, with respect to the relationship and role • Understands and complies with all company Privacy and Security standards • Other duties as assigned

- Provide technical contributions in a fast-paced R&D team environment to accelerate our efforts on building new analytics. - Utilize advanced mathematical models, machine learning algorithms, operations research techniques, and strong business acumen to deliver insight, recommendations, and solutions. - Analyze data sets and develop models to predict fraud, waste, and abuse. - Document and present results to internal team members for development and inclusion in company products and analysis. - Satisfies all applicable requirements imposed by applicable Company customers, clients, or business partners, with respect to the relationship and role. - Understands and complies with all company Privacy and Security standards. - This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

• Administer, monitor, and maintain Windows Server environments (physical and virtual). • Monitor system logs, security alerts, and performance metrics to proactively identify and resolve issues. • Troubleshoot and resolve hardware, software, networking, and infrastructure-related issues. • Manage patching and vulnerability remediation across all servers and endpoints. • Ensure adherence to IT operations procedures, security standards, and change management protocols. • Assist with deployment, configuration, and maintenance of new and existing servers and infrastructure components. • Collaborate with external vendors for support, implementation, and maintenance activities. • Contribute to the company’s Information Security Management Program (ISMP), including: • Performing security monitoring and audit activities • Supporting policy development and compliance initiatives • Assisting with HITRUST CSF compliance efforts • Evaluate and recommend hardware and software solutions to enhance system performance and security.

• Take full ownership of assigned projects and deliver high-quality solutions from development through deployment and support. • Design, develop, and maintain claim import implementations. • Troubleshoot, enhance, and support the scoring workflow processes. • Ensure data security and confidentiality in compliance with company standards. • Understands and complies with all company Privacy and Security standards. • Participate in ongoing professional development and continued learning initiatives. • Participate in an on-call support rotation to provide after-hours coverage for critical systems and applications.

• Manage multiple installation projects concurrently. • Organize and lead internal and external project meetings to discuss project goals, deliverables, and progress. • Create, maintain, and adjust project documentation including project plan timelines, status reports, daily updates, and more. • Consider staff / departmental resources for projects. • Coordinate project team members both internally and externally as needed. • Apply strong project management and organizational skills to implementation processes. • Provide regular status updates to both internal staff and client resources. • Manage project schedules and timelines in project management software and other company project templates. • Understand and comply with all company Privacy and Security standards. • Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.

• Own and drive the end-to-end technical implementation of IT projects for new and existing clients. • Ensure accurate and seamless data transfers and migrations. • Proactively communicate status across teams. • Troubleshoot any post-install matters. • Act as the central point of coordination throughout the implementation lifecycle by setting expectations, managing timelines, and resolving issues. • Ensure a smooth client experience.