Healthcare fraud, waste & abuse (fwa) qa & ai validation specialist

PLEASE NOTE BEFORE APPLYING:

CODOXO IS NOT ABLE TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE FUTURE

Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry.

Position Summary:

We are seeking a Healthcare Fraud, Waste, and Abuse (FWA) QA & AI Validation Specialist to support the validation and quality assurance of AI-driven healthcare fraud detection and investigative solutions. This role combines healthcare investigative expertise with software quality assurance to ensure our applications accurately identify, prioritize, and support the investigation of suspected fraud, waste, and abuse.

The ideal candidate possesses extensive experience conducting healthcare fraud investigations and understands the investigative lifecycle, claims analysis, provider billing patterns, and regulatory requirements. This individual will leverage that expertise to validate AI-generated investigative insights, execute manual testing, identify defects, and ensure software solutions meet both technical and business expectations.

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:

Required 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.
• Remote Work Requirements: To ensure reliable performance on the company-issued CODOXO laptop, employees working remotely must have a stable high-speed internet connection. Internet performance should be measured using a speed test conducted directly on the CODOXO laptop, not based solely on the internet plan purchased from the provider.
• Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk.

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 prompt validation and AI response evaluation.

Desired Competencies

• Strong attention to detail
• Analytical and critical thinking
• Effective communication and collaboration
• Ability to manage multiple priorities
• Commitment to delivering high-quality software
• Adaptability in a rapidly evolving technology environment
• Passion for improving software quality and user experience

Remote Work Requirements: To ensure reliable performance on the company-issued CODOXO laptop, employees working remotely must have a stable high-speed internet connection. Internet performance should be measured using a speed test conducted directly on the CODOXO laptop, not based solely on the internet plan purchased from the provider.

Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk.

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.

Benefits for You

• Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
• Unlimited PTO
• Annual Professional Development stipend
• Annual home office stipend
• 401K Match (after 90 days)

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.