Investigative Analyst, CMS Healthcare Claims

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide support to the Centers for Medicare and Medicaid (CMS)

• Analyze healthcare claims data to identify trends

• Generate leads and referrals for Healthcare Fraud Prevention Partnership members and the Trusted Third Party related to fraud, waste, and abuse

• Conduct analytical tasks that bolster the HFPP program

• Utilize internal tools for data mining across the partnership

• Collaborate in the creation of HFPP analytic reports

• Develop referrals and leads based on findings from HFPP analytic reports

• Monitor outcome metrics related to referrals and leads shared with partners

• Engage regularly with partners concerning identified referrals and leads

• Participate in potential business development activities, including analyzing health claims data, generating study referrals and leads, crafting provider background profiles, and spotting collaboration opportunities

⛳️ Requirements

• BA/BS degree or equivalent professional experience

• Over 8 years of experience in healthcare claims analysis

• Equivalent work experience may be accepted in place of a degree

• Exceptional oral and written communication skills, with the ability to present to management-level personnel

• Advanced proficiency in the Microsoft Office suite

• Familiarity with Tableau, Amazon WorkSpaces, Jira, and Confluence

• Solid understanding of HIPAA privacy and security regulations

• Capability to identify trends in healthcare claims data

• Strong decision-making, organizational, and prioritization abilities

• Capacity to work independently and with minimal supervision on complex projects

• Skill in building effective relationships and exhibiting interpersonal skills

• Ability to thrive in both team environments and independent work settings

• Work visa sponsorship is not available

🏝️ Benefits

• Comprehensive medical plan options, including some with Health Savings Accounts

• Dental plan options available

• Vision plan included

• 401(k) plan with company matching

• Flexible work weeks

• Paid time off encompassing vacation, sick leave, personal time, holidays, parental leave, military leave, bereavement leave, and jury duty leave

• Typically 15 days of paid leave per calendar year

• 10 paid holidays each year

• Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees

• Short-term and long-term disability benefits offered

• Life insurance coverage

• Accidental death and dismemberment insurance

• Personal accident insurance

• Critical illness insurance coverage

• Business travel and accident insurance

• AI-driven career tool that identifies career progression steps and learning opportunities

• Internal mobility team available

• Recognized culture of innovation

• Military-friendly workplace