Senior Analyst, Healthcare Fraud, Waste and Abuse

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

📋 Description

• Act as a business consultant for the organization by delivering reports and analyses that support Program Integrity as well as Fraud, Waste & Abuse prevention efforts.

• Convert evaluation inquiries into analytical plans.

• Build analytical datasets.

• Generate relevant data summaries.

• Execute valid data comparisons and statistical analyses.

• Direct and enhance reporting and analytics programs to produce insights and drive actions that support FWA prevention.

• Perform in-depth claims trend analysis and drill-down evaluations to pinpoint actionable FWA risks across various member and provider demographics and cost categories.

• Collaborate with clinical strategy teams to establish intervention and comparison cohorts.

• Create valid performance metrics and ensure suitable use of enterprise data.

• Analyze member populations and discover opportunities for new service offerings.

• Forecast potential savings through multivariable analyses.

• Identify cost-saving opportunities by assessing care utilization, practice patterns, negotiations, and contract performance.

• Suggest enhancements aimed at reducing care costs.

• Assess the financial implications of contracts, RFPs/RFIs, and operational initiatives.

• Offer data-driven recommendations and reports to facilitate management decision-making.

⛳️ Requirements

• Bachelor's Degree.

• Over 5 years of experience in a comparable role within a healthcare payer or provider organization.

• Knowledge of common statistical techniques, including regression, propensity matching, and analysis of variance.

• Proficiency in database query languages such as SQL or SAS.

• Experience utilizing Python or R for data analysis, extraction, and manipulation.

• Familiarity with Tableau or PowerBI for data visualization.

• Background in analytic automation, including scripting or macros.

• Experience with enterprise data warehouses and commercial/Medicare/Medicaid claims data.

• Capability to read, analyze, and interpret technical documents and financial data.

• Skill in presenting information effectively in small group settings to both internal and external stakeholders.

• Ability to perform complex arithmetic and intermediate algebra for spreadsheet and report preparation.

• Advanced graphical skills for creating clear and comprehensible reports.

• Willingness to undergo a background check upon hiring and throughout employment, which includes criminal, employment, education, healthcare sanctions, prohibited parties, sex offender registry, and 10-panel drug screening.

• Access to high-speed internet service with a minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds.

• Capability to work from a quiet workspace with minimal background noise.

• Strong analytical and data management skills.

• Excellent oral and written communication and presentation abilities.

• Ability to work independently as well as collaboratively within a team.

• Proficiency in working effectively with individuals at all levels of the organization.

• Competence in appropriately scoping and executing evaluation and analysis tasks.

• High level of integrity and ethical standards.

• Ability to identify compliance discrepancies.

• Outstanding communication and interpersonal skills.

🏝️ Benefits

• Annual performance-based discretionary incentive.

• Coverage for medical, dental, and vision needs.

• 401(k) plan with competitive employer matching.

• Company-funded life and disability insurance.

• Paid parental leave and wellbeing incentives.

• Generous paid time off, which includes time for volunteering.

• Flexible spending accounts for healthcare and dependent care expenses.

• Opportunities for professional development and tuition reimbursement.

• Flexibility for remote work (role-dependent).

• Company-provided equipment.

• Potential for significant personal and professional growth.