I'm a results-driven fraud and compliance professional with 20+ years of experience across healthcare, financial services, and insurance sectors. I specialize in detecting and preventing Fraud, Waste, and Abuse (FWA) in Medicare, Medicaid, and ACA programs — combining deep domain expertise with data analytics to identify patterns, reduce losses, and protect program integrity.
Currently building a focused analytics portfolio demonstrating real-world fraud detection skills in SQL, Python, and data automation.
- Fraud Detection & Investigation — SIU, FWA, AML/KYC, claims fraud patterns
- Healthcare Claims Review — Medicare, Medicaid, ACA, medical billing audits
- Data Analytics — SQL queries, Python scripting, statistical anomaly detection
- Regulatory Compliance — CMS guidelines, HIPAA, anti-fraud regulations
- Reporting & Documentation — Case documentation, SAR filing, decision tree logic
| Repo | Description |
|---|---|
| fraud-detection-sql | SQL queries for detecting fraud patterns in transactions, accounts, and claims |
| transaction-anomaly-detection | Python script for detecting anomalies in transaction data using statistical methods |
| fraud-rules-engine | Rule-based fraud detection logic and decision trees |
| data-analysis-automation | Python and Excel automation for data analysis and business intelligence reporting |
- Anti-Money Laundering (AML) Certified
- Fraud, Waste & Abuse (FWA) Certified
- ACA Certified
- Healthcare Compliance Training
- LinkedIn: linkedin.com/in/kaspears
- Open to: Fraud Analyst | Claims Analyst | FWA Investigator | Claims Examiner | Healthcare Data Analyst
- 100% Remote | Available Immediately