Financial Analyst - Fraud, Waste and Abuse (FWA) (Onsite)
Coral Gables, Florida, United States · On-site
Mid level
Onsite Position The Financial Analyst - Fraud, Waste and Abuse (FWA) is responsible for identifying, investigating and preventing fraudulent, wasteful and abusive activities related to healthcare claims, insurance, gover…
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Coral Gables, Florida, United States · On-site
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Regions
Relationship Banker II - Le Jeune Branch
Coral Gables, Florida, United States · On-site
$48k–$58k/yr
Entry level
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Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
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Full-time
bachelor degree
Posted 11d ago
Apply by Nov 30
~40 hrs/week
Responsibilities
The Financial Analyst is responsible for identifying, investigating, and preventing fraudulent, wasteful, and abusive activities within healthcare claims. This role involves performing data mining, auditing, and trend analysis to detect suspicious patterns and support payment integrity.
Requirements
Candidates must hold a bachelor's degree and possess at least three years of experience in healthcare or Medicare Advantage plans. Proficiency in SQL, Excel, and PowerBI is required, along with strong analytical and communication skills.
Full job description
Onsite Position
The 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.
Welcome to Doctors HealthCare Plans! Doctors HealthCare Plans, Inc., is a Florida-based, locally owned health plan providing coverage in Miami-Dade and Broward Counties and specializing in Medicare. We have an extensive list of participating providers, hospitals and pharmacies. Whether you are a Doctors HealthCare Plans member or provider, all inquiries and requests are addressed by a friendly and local Team.
Offices: 2020 PONCE DE LEON BLVD, Coral Gables, Florida 33134, US
How many Finance & Accounting jobs are open in Coral Gables, FL right now?
There are currently 340 open finance & accounting positions in Coral Gables, FL listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Finance & Accounting roles in Coral Gables, FL?
Companies currently hiring include University of Miami Health System-Uhealth, City National Bank of Florida, University of Miami Health System, Cherry Bekaert, Citrin Cooperman, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Finance & Accounting jobs in Coral Gables, FL?
Yes — 94 of the 340 open finance & accounting positions offer remote or hybrid work (28 remote, 66 hybrid).
How do I apply for Finance & Accounting jobs in Coral Gables, FL?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.