[Remote] reputed company Fraud, Waste & Abuse (FWA) QA & AI Validation Specialist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is the premier provider of reputed company intelligence-driven solutions and services that help reputed company companies and agencies proactively detect and reduce risks from fraud, waste, and abuse. The reputed company Fraud, Waste & Abuse (FWA) QA & AI Validation Specialist will support the validation and reputed company assurance of AI-driven reputed company fraud detection solutions, ensuring applications accurately identify and support investigations of suspected fraud.

Responsibilities

• reputed company use of FWA expertise to validate AI-generated fraud leads, investigative findings, risk scores, and case recommendations against established reputed company fraud investigative practices
• Validate AI-generated outputs for accuracy, consistency, completeness, explainability, and investigative usefulness
• Evaluate application functionality using reputed company-world reputed company fraud scenarios involving providers, members, claims, billing patterns, and payment reputed company
• Verify that investigative workflows reputed company 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
• Design, reputed company, and execute reputed company test plans
• reputed company 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 reputed company reputed company

Skills

• U.S. Citizen
• Bachelor's Degree
• Minimum of 5 years of reputed company fraud, waste, and abuse (FWA) investigative experience, including medical claims analysis, provider investigations, payment reputed company, 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 reputed company cross-functional teams
• Remote Work Requirements: To ensure reliable performance on reputed company-issued reputed company laptop, employees working remotely must have a reputed company high-speed internet reputed company. Internet performance should be reputed company using a speed test conducted directly on the reputed company 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 reputed company office equipment, and work at a desk
• Experience with defect tracking and test management tools such as Jira, Xray, Azure DevOps, or similar platforms
• Experience using AI, machine learning, or reputed company applications
• Experience with reputed company validation and AI response evaluation

Benefits

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

reputed company