Senior Compliance Analyst, Special Investigations Unit

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

📋 Description

• Evaluate extensive datasets to uncover patterns, trends, and anomalies that suggest fraudulent activities, employing advanced analytical methods and tools to aid in the creation of investigative leads.

• Work in conjunction with auditors and investigators to generate reports and educational letters for providers.

• Oversee quarterly CMS fraud reports and regulatory memos to assess whether Devoted is exposed to any fraud, waste, and abuse (FWA) risks.

• Manage the intake and prioritization of referrals concerning fraud, waste, and abuse from both internal and external sources.

• Create detailed reports that summarize analyses and trends, including recommendations for targeted audits and investigations.

• Collaborate closely with internal departments (such as Payment Integrity, Claims, Clinical Escalations) to disseminate findings and coordinate on the development of concepts and FWA scheme targeting criteria.

• Design educational materials aimed at internal and external stakeholders (including providers, members, and employees).

• Perform quality assurance (QA) reviews of case documentation.

• Attend and engage in SIU and PI status meetings (weekly, bi-weekly, quarterly, and as needed).

• Keep abreast of pertinent laws, regulations, and industry standards related to healthcare fraud, contributing to compliance initiatives.

⛳️ Requirements

• Bachelor’s degree in business, healthcare administration, criminal justice, or a related discipline.

• At least 3 years of experience in healthcare fraud investigation, medical claims analysis, or a similar field.

• Proficiency in data analysis tools (such as Excel/Google Sheets) and familiarity with statistical analysis techniques.

• Strong analytical and problem-solving abilities, with the capacity to interpret complex data and derive actionable insights.

• Excellent verbal and written communication skills, capable of clearly presenting findings to a range of audiences.

• Exceptional attention to detail and precision in data analysis and reporting.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plan with low or no premium.

• Generous paid time off.

• $100 monthly mobile or internet stipend.

• Stock options available for all employees.

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles.

• Parental leave program.

• 401K program.

• And more....