The Sr. FWA Analyst identifies fraud, waste, and abuse in medical billing through data analysis, supporting engineering and data science teams with validation and tuning of detection algorithms.
Description
Bluespine is an innovative new startup in the health-IT domain. By employing cutting-edge technologies, Bluespine is developing an engine that detects errors in medical billing, which causes billions of dollars in losses across the entire industry. Bluespine can offer personalized precision by tailoring assessments to each unique medical claim, considering the relevant provider, payer, and plan, and ensuring unparalleled accuracy.
We are looking for a Sr. FWA Analyst experienced in discovering medical billing errors and fraudulent billing patterns of medical claims for commercial payers.
Responsibilities
- Proactively identify potential instances of fraud, waste, and abuse through data analysis using company systems and tools
- Support engineering and data science teams with audit and FWA concepts, data mapping, and defining data requirements
- Determine the likelihood of cases being true error/fraud, based on real-life experience.
- Validate and help to tune anomaly detection algorithms.
- Hands-on experience exploring and investigating potential medical billing errors/fraud using analytic and SQL/graph-based tools.
- Extensive knowledge of medical terminology, medical records, health information management, medical coding, DRG methodologies, CPT/HCPCS coding guidelines, physician specialty guidelines, reimbursement programs, claims adjudication processes, member contract benefits, regulatory agency policies (CMS/HCFA, DOI, state regulations), and provider billing systems and practices.
- Strong analytical skills and ability to approach tasks in a scientific manner.
- Background in SIU or Payment Integrity.
- Independent, Organized, and with excellent communication skills.
Advantages
- Medical/clinical background.
- Experience with Pharma claims.
- Billing/coding experience.
Team8 New York, New York, USA Office
488 Madison Ave, 11th floor, New York, New York, United States, 10022
Similar Jobs
Artificial Intelligence • Blockchain • Fintech • Financial Services • Cryptocurrency • NFT • Web3
Design, build, and scale highly available backend and frontend systems powering Coinbase trading experiences for millions of users. Architect extensible support for multiple trading types and assets, evolve critical production infrastructure, partner with product and design, and promote engineering quality through code reviews, mentorship, and knowledge sharing.
Top Skills:
Generative AiGoJavaMongoDBRedis
Information Technology • Machine Learning • Software • Conversational AI • Generative AI • Manufacturing
The Account Executive will grow revenue across existing and prospective B2B accounts by developing territory plans, generating pipeline, managing sales opportunities, maintaining accurate CRM forecasts, presenting software and data solutions, negotiating agreements, and closing deals. The role partners with sales engineering, product, services, legal, and finance teams while engaging engineering, technical, and procurement stakeholders. Success requires consistent quota attainment, strong communication, commercial judgment, and disciplined pipeline management.
Top Skills:
AICRM
Information Technology • Machine Learning • Software • Conversational AI • Generative AI • Manufacturing
Build and lead Accuris’s customer growth marketing capability, driving adoption, upsell, cross-sell, account expansion, pipeline, and ARR. Responsibilities include segmenting the installed base, identifying expansion opportunities, launching targeted campaigns, developing propensity and whitespace models, enabling Sales and Customer Success, improving product adoption, and connecting marketing activity to revenue outcomes. The role establishes scalable customer growth plays and operating processes while executing campaigns rapidly.
Top Skills:
Account-Based MarketingAICRMIntent DataMarketing AutomationProduct Usage Analytics
What you need to know about the NYC Tech Scene
As the undisputed financial capital of the world, New York City is an epicenter of startup funding activity. The city has a thriving fintech scene and is a major player in verticals ranging from AI to biotech, cybersecurity and digital media. It also has universities like NYU, Columbia and Cornell Tech attracting students and researchers from across the globe, providing the ecosystem with a constant influx of world-class talent. And its East Coast location and three international airports make it a perfect spot for European companies establishing a foothold in the United States.
Key Facts About NYC Tech
- Number of Tech Workers: 549,200; 6% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Capgemini, Bloomberg, IBM, Spotify
- Key Industries: Artificial intelligence, Fintech
- Funding Landscape: $25.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Greycroft, Thrive Capital, Union Square Ventures, FirstMark Capital, Tiger Global Management, Tribeca Venture Partners, Insight Partners, Two Sigma Ventures
- Research Centers and Universities: Columbia University, New York University, Fordham University, CUNY, AI Now Institute, Flatiron Institute, C.N. Yang Institute for Theoretical Physics, NASA Space Radiation Laboratory

.png)
