CoventBridge Group

As a Data Analyst II, you will conduct thorough evaluations and advanced analyses of potential fraud cases and data inquiries by leveraging claims information and multiple data sources. You will provide critical support in developing complex, high-value, or sensitive cases that warrant referral to law enforcement or recovery of overpayments.

As an Investigative Clinician, you will blend clinical expertise with investigative acumen to detect, prevent, and resolve fraudulent, exaggerated, or non-medically necessary claims. You'll collaborate with adjusters, legal teams, and investigators to analyze medical documentation and uncover inconsistencies or red flags. Responsibilities include reviewing medical records, identifying patterns of fraud, providing clinical expertise, interviewing claimants, and preparing clinical summary reports.

The Junior Data Scientist will apply modern programming, statistical, and machine learning techniques to healthcare claims data, supporting the detection of fraud, waste, and abuse (FWA). This role is designed for an early-career professional who combines strong technical skills with a desire to learn the nuances of healthcare analytics and compliance.