RN Clinical Fraud & Risk Analyst

FedPoint; Portsmouth (NH); Hybrid; USD 72,000 - 97,000; Full time

Benefits offered by this job

401k match

Bonus opportunity

Paid time off

Health benefits

Parental leave

Tuition reimbursement

Volunteer program

Wellness program

Job summary

FedPoint, headquartered in Portsmouth, NH, seeks a Registered Nurse to join its Claims Risk Management team as a Claims Fraud Clinical Analyst (CFCA). This role uses clinical expertise to detect, prevent, and minimize fraud, waste, and abuse within a long-term care insurance program, collaborating with clinical, claims, compliance, and investigative teams.

Location: Portsmouth, NH; Schedule: Full-time, Hybrid 2 days per week in office; Salary range: $71,885 – $97,257 per year with potential for

Qualifications

• Current, unrestricted Registered Nurse (RN) license.
• Minimum of 5 years of nursing experience in a variety of healthcare settings.
• Strong knowledge of clinical documentation and healthcare delivery practices.
• Exceptional analytical, investigative, and critical-thinking skills.
• Excellent verbal and written communication abilities.
• Ability to work independently while collaborating effectively across departments.

Responsibilities

• Review and analyze medical records, benefit eligibility assessments, independent medical examinations, and claims documentation.
• Investigate high-risk claims and referrals involving potential fraud, waste, or abuse.
• Conduct clinical reviews to support active investigations and risk assessments.
• Evaluate claimant eligibility, provider utilization, billing patterns, and care plans.
• Collaborate with Care Coordination, Claims, Customer Service, Compliance, and Risk Management teams.
• Communicate professionally with claimants, healthcare providers, attorneys, and internal stakeholders.
• Prepare referrals for Special Investigation Units and forensic investigation teams.
• Identify trends, risks, and opportunities to strengthen fraud prevention efforts.
• Maintain professional licensure and complete required continuing education.

Skills

RN license

Nursing experience

Analytical skills

Investigation skills

Communication skills

Independent worker

Education

Nursing degree

Job description

FedPoint, headquartered in Portsmouth, NH, seeks a Registered Nurse to join its Claims Risk Management team as a Claims Fraud Clinical Analyst (CFCA). This role uses clinical expertise to detect, prevent, and minimize fraud, waste, and abuse within a long-term care insurance program, collaborating with clinical, claims, compliance, and investigative teams.

Location: Portsmouth, NH; Schedule: Full-time, Hybrid 2 days per week in office; Salary range: $71,885 – $97,257 per year with potential for