US healthcare professional with 3.5+ years of experience in medical claims processing, Fraud, Waste & Abuse (FWA/FWAE), and revenue cycle management. Strong expertise in claims integrity, denial management, fraud investigations, and compliance. Experienced in working with US payers, providers, and insurance workflows, ensuring adherence to CMS, Medicare, Medicaid, and HIPAA regulations. Seeking a high pay, voice / non- voice WFH role in operations. Open to switch domains.
Fraud Analyst — Optum Global Solutions, Noida
Aug 2024 – Present
• Review medical & pharmacy claims to detect Fraud, Waste, Abuse, and Errors (FWAE)
• Analyse billing patterns and utilization trends to identify suspicious activity
• Conduct provider/member outreach and verify medical records
• Maintain investigation documentation and case files
• Collaborate with SIU, compliance, and clinical teams
• Ensure compliance with CMS, Medicare, Medicaid, HIPAA
