Manager - Fraud, Waste & Abuse AI Engineer

Job Overview

The role of the Manager - FWA AI Engineer involves designing, crafting, testing, and deploying artificial intelligence solutions tailored to Fraud, Waste & Abuse detection and investigation efforts. This position translates authorized business needs and data science models into scalable production-ready applications. It integrates AI functionalities seamlessly into operational workflows, guaranteeing efficiency, reliability, and measurable business value. The position collaborates closely with the FWA Lead, Data Scientist, investigators, and various stakeholders to successfully launch and continuously refine AI use cases addressing fraud.

Primary Responsibilities

• Evaluate the technical feasibility of sanctioned FWA use cases by assessing data accessibility, technical prerequisites, and implementation complexity.
• Design solution strategies incorporating the most effective AI techniques and technologies pertinent to FWA detection.
• Formulate detailed technical requirements and project execution plans.
• Create and optimize AI systems that bolster the FWA detection and investigative procedures.
• Convert analytical models and logic into scalable, cloud-native platforms on Google Cloud Platform.
• Develop machine learning models, anomaly detection methods, graph analytics, and document intelligence workflows.
• Build APIs, scoring services, and integration components essential for operation deployment.
• Ensure solutions are scalable and maintainable while adhering to established technical standards.
• Work alongside the FWA Data Scientist to bring validated models into production use.
• Manage deployment of AI solutions into production, assuring seamless integration with internal platforms and workflows.
• Collaborate with Data Engineering and IT teams to facilitate operational deployment and release activities.
• Support technical and user acceptance testing to verify accuracy, reliability, and performance in accordance with business and tech requirements.
• Undertake continuous improvement of deployed AI solutions, incorporating enhancements from the Data Science team and adapting to evolving fraud detection needs.
• Maintain comprehensive technical documentation and knowledge base related to the AI solutions.

Required Skills and Expertise

• Proficiency in Python programming
• Experience with SQL for data querying and manipulation
• Hands-on knowledge of Google Cloud Platform (GCP), including Vertex AI
• Strong background in implementing machine learning models and AI solution development
• Competency in API development and system integration
• Knowledge of natural language processing and large language model applications
• Understanding of document intelligence technologies including OCR
• Familiarity with software development best practices and testing methodologies
• Ability to troubleshoot, problem solve, and ensure high-quality delivery
• Excellent communication and presentation skills for stakeholder engagement
• Experience delivering AI/ML solutions into production environments is essential
• Preferred experience includes healthcare insurance domains, claims processing, risk analytics, and financial crime detection
• Additional advantage if knowledgeable about healthcare claims, provider workflows, pre-authorization processes, and SAS software

Education and Eligibility

A bachelor's degree in Computer Science, Software Engineering, Artificial Intelligence, or Data Science is required.