Healthcare Fraud, Waste & Abuse (FWA) QA & AI Validation Specialist

Key Responsibilities

• Ai Product Validation
• Make use of FWA expertise to validate AI-generated fraud leads, investigative findings, risk scores, and case recommendations against established healthcare fraud investigative practices.
• Validate AI-generated outputs for accuracy, consistency, completeness, explainability, and investigative usefulness.
• Evaluate application functionality using real-world healthcare fraud scenarios involving providers, members, claims, billing patterns, and payment integrity.
• Verify that investigative workflows align with industry best practices and organizational business requirements.
• Assess AI-generated summaries, recommendations, and supporting evidence for investigative accuracy, completeness, consistency, and relevance.
• Identify gaps, false positives, false negatives, and inconsistencies in fraud detection logic and AI-generated outputs.
• Collaborate with product managers, data scientists, investigators, and engineering teams to improve fraud detection capabilities and investigative workflows.
• Software Quality Assurance
• Design, develop, and execute manual test plans.
• Perform production validation testing following application releases.
• Participate in release readiness activities and production verification.
• Document defects, reproduce issues, and work closely with development teams to ensure timely resolution.

Qualifications

• U.S. Citizen.
• Bachelor's Degree Minimum of 5 years of healthcare fraud, waste, and abuse (FWA) investigative experience, including medical claims analysis, provider investigations, payment integrity, or Special Investigations Unit (SIU) operations.
• Strong analytical, troubleshooting, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively within cross-functional teams.

Preferred Qualifications

• Experience with defect tracking and test management tools such as Jira, Xray, Azure DevOps, or similar platforms.
• Experience using AI, machine learning, or generative AI applications.
• Experience with defect tracking and test management tools such as Jira, Xray, Azure DevOps, or similar platforms.
• Experience with prompt validation and AI response evaluation.

Accessibility Notice

If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis.