[Hiring] Senior SIU Analyst - FWA Detection @Iconma Portal

Role Description

• Review claims flagged by detection logic and determine true positive vs. false positive.
• Articulate the specific billing pattern, code combination, or provider behavior driving each call.
• Carry select flagged leads through to a documented, substantiated finding.
• Partner with product and data science teams to translate investigative judgment into refined detection rules.
• Track progress against substantiation-rate and findings-volume targets (set once POC window and initial data are confirmed).
• Write a findings/recommendation memo — scale, iterate, or kill — for internal stakeholders.
• Present findings clearly to non-investigator audiences (product, compliance, leadership).

Qualifications

• 4+ years FWA investigative experience, payer-side preferred.
• Direct exposure to claims coding logic (CPT/HCPCS, ICD-10, DRG/APC).
• Must have prior experience starting cold on a live data feed.
• Comfortable working from partial/imperfect data — sample extracts, not a finished production system.
• Certification required: AHFI, CFE, or CPC/CPMA.
• SQL or equivalent self-serve query ability.
• Familiarity with edit/rules logic (e.g., NCCI edits).
• Bachelor's degree, or 7+ years relevant experience in lieu.

Benefits

• Health Benefits.
• Referral Program.
• Excellent growth and advancement opportunities.