Job Description
Responsibilities:
- 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)
Requirements:
- 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
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
Numbers & Facts
| Location | Remote, MD (Remote) |
| Industry | Management Consulting Services |
| Salary | $67.94–$72.43 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | https://www.iconma.com/ |
Benefits
401K, Employee Referral Program, Life Insurance
About Company
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.
Skills
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