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Fwa Auditor Jobs (NOW HIRING)

CVS Health

Program Integrity Auditor

$46K - $122K/yr

The Auditor must have the ability to determine correct coding and appropriate documentation during ... Identify aberrant billing patterns and potential FWA, reporting this to internal staff. Assisting ...

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Fwa Auditor information

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$38.5K

$92.8K

$151K

How much do fwa auditor jobs pay per year?

As of Sep 14, 2026, the average yearly pay for fwa auditor in the United States is $92,797.00, according to ZipRecruiter salary data. Most workers in this role earn between $72,000.00 and $112,000.00 per year, depending on experience, location, and employer.

What is an FWA auditor?

FWA Auditors are professionals responsible for detecting, investigating, and preventing Fraud, Waste, and Abuse (FWA) within organizations, particularly in sectors like healthcare and insurance. They review claims, analyze patterns, and ensure compliance with regulatory standards to protect company resources and maintain ethical practices. FWA Auditors often work closely with compliance teams and law enforcement to identify suspicious activities and recommend corrective actions. Their work is crucial in minimizing financial losses and maintaining trust in organizational systems.

What are some common challenges FWA auditors face when investigating potential fraud, waste, or abuse cases?

FWA Auditors often encounter challenges such as interpreting large volumes of complex data, staying current with evolving regulations, and distinguishing between genuine errors and intentional wrongdoing. The role requires meticulous attention to detail and strong analytical skills, as even minor oversights can lead to incorrect conclusions. Additionally, FWA Auditors frequently collaborate with compliance, legal, and operations teams to gather relevant information and ensure thorough investigations, which requires effective communication and teamwork.

What are the key skills and qualifications needed to thrive as an FWA auditor, and why are they important?

To thrive as a FWA (Fraud, Waste, and Abuse) Auditor, you need strong analytical skills, attention to detail, and a background in healthcare, finance, or compliance, often supported by a relevant degree or certification such as Certified Fraud Examiner (CFE). Familiarity with data analysis tools, claims management systems, and audit software is typically required. Exceptional critical thinking, integrity, and effective communication are important soft skills for identifying irregularities and presenting findings. These capabilities are crucial for detecting and preventing fraudulent activities, ensuring regulatory compliance, and safeguarding organizational resources.

What is the difference between Fwa Auditor vs Fwa Inspector?

AspectFwa AuditorFwa Inspector
CertificationsTypically requires safety and compliance certifications, such as OSHA or industry-specific credentialsOften requires similar safety certifications, with a focus on inspection-specific qualifications
Work EnvironmentConducts audits, reviews documentation, and assesses compliance remotely or on-sitePerforms on-site inspections, monitoring work sites for safety and code adherence
Employer & Industry UsageUsed by construction firms, safety agencies, and regulatory bodies to ensure complianceEmployed by construction companies, safety agencies, and inspectors to verify site safety

While both roles focus on safety and compliance within the construction industry, Fwa Auditors primarily review documentation and conduct audits, whereas Fwa Inspectors perform on-site inspections to ensure safety standards are met.

What are popular job titles related to Fwa Auditor jobs?

For Fwa Auditor jobs, the most frequently searched job titles are:

Infographic showing various Fwa Auditor job openings in the United States as of September 2026, with employment types broken down into 91% Full Time, 6% Part Time, 2% Contract, and 1% Nights. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $92,797 per year, or $44.6 per hour.

FWA Auditor

Westborough, MA • On-site

University of Massachusetts Medical School
Education • 10K+ employees
Learn more about University of Massachusetts Medical Schoolexternal

$80K - $95K/yr

Full-time

Re-posted 14 days ago

Key responsibilities

  • Perform desk and onsite audits to assess compliance with federal and state regulations.

  • Conduct data mining, claims analysis, and medical record assessments to identify potential fraud, waste, or abuse.

  • Prepare audit documentation, communicate findings to providers, and update case-tracking systems.

Job description

Overview
Under the general direction of the Associate Director or designee, the Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in identifying, investigating, and preventing fraud, waste and abuse for Medicaid programs. A major function of this position is to conduct desk and onsite audits across various provider types to ensure compliance with federal and state regulations. The Auditor performs investigative activities to develop leads and detect aberrant billing practices, including data mining, claims analysis, and medical record assessment.
Onsite requirement 1-2 times per month, all other aspects of the job are remote.
Responsibilities
Responsibilities:
  • Ensure compliance with federal and state regulations and healthcare FWA industry standards.
  • Perform independent data mining and data analysis utilizing claims data to detect patterns and trends that may uncover fraud, waste, or non-compliant billing practices.
  • Conduct onsite audits as required, to assess the completeness of medical and administrative records and the compliance with applicable regulatory requirements.
  • Prepare detailed audit documentation, summaries of investigative findings, compile case files, calculate sanctions and overpayments based on violations cited.
  • Communicate with providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.
  • Recommend policy, procedure and system changes to enhance investigative outcomes.
  • Update appropriate internal management staff regularly on progress of investigations.
  • Stay current with regulatory updates, coding changes, and industry standards.
  • Identify trends from national fraud-related publications and recommend new or improved strategies to strengthen fraud-detection efforts.
  • Assist with document management, updating case-tracking system and adhering to record retention policies and procedures.
  • Perform other duties as assigned.

Qualifications
Qualifications:
  • Bachelor's degree in business, health care administration, or other related field or other related field or an equivalent combination of education and experience
  • 4-6 years of related experience in the healthcare industry, business,; with at least two years of experience conducting data mining in the healthcare insurance industry, healthcare claim audits, administrative medical record reviews or other claims analysis related experience
  • Knowledge of CPT, HCPCS and ICD-10 coding, reimbursement and claims processing policies
  • Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions
  • Ability to interpret and apply law and regulations as it relates to fraud and fraud investigations
  • Ability to multi-task, establish priorities and work independently and collaboratively to achieve audit objectives
  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint and Access)
  • Excellent Customer service skills with the ability to interact professionally and effectively with providers, clients, and internal stakeholders from all departments
  • Ability to travel within Massachusetts and be on-site as needed for audits

Additional Information
Preferred Qualifications:
Prefer individual possessing any of the following certifications or licensure: CPC or CPMA
Knowledge of state and federal regulations as they apply to public assistance programs
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