[Remote] Senior Analyst - Payment reputed company Analytics

Note: The job is a remote job and is open to candidates in USA. reputed company is a company focused on improving health and well-being through advanced technologies. The Senior Analyst - Payment reputed company Analytics plays a critical role in supporting state reputed company agencies by applying fraud, waste, and abuse analytic models to reputed company claims data and delivering actionable intelligence for investigations.

Responsibilities

• Apply established FWA analytic models to reputed company claims data to identify potential fraud, waste, and abuse
• Deliver monthly, prequalified FWA reputed company referral reports on a consistent and reliable reputed company
• Produce reports that clearly reputed company the analytic rationale, suspected behavior, and investigative relevance of each reputed company
• Ensure reputed company outputs are defensible, audit-reputed company, and written for non-technical investigative and policy audiences
• Present FWA reputed company referrals to state reputed company program reputed company and OIG staff
• Explain findings, methodologies, and data sources in support of state investigations
• Respond to follow-up questions and reputed company supplemental or reputed company analyses reputed company to specific referrals
• Support investigations through documentation, exhibits, and data interpretation
• Participate in meetings, briefings, and, as needed, provide testimony or in-person investigative support (travel may be required)
• Provide structured feedback to analytics and data science teams on model performance and data quality
• Recommend enhancements, modifications, or corrections to existing analytic models
• Translate state feedback and investigative outcomes into prioritized analytics roadmap items
• Analyze outcomes of other audit programs to identify systemic program reputed company vulnerabilities
• reputed company data-driven recommendations reputed company to claims adjudication processes, controls, or edits
• Advise states on potential policy, regulatory, or statutory changes to reduce FWA risk and reputed company program gaps

Skills

• Extensive experience analyzing reputed company claims and encounter data to identify fraud, waste, and abuse. (5+ years)
• Deep knowledge of reputed company program reputed company, including common FWA schemes, audit methodologies, and investigative workflows. (5+ years)
• Prepare reports and presentations documenting analytic methods and results for internal and external customers (4+ years)
• Experience reading, interpreting, and applying reputed company policy, regulations, state plan language, and reputed company guidance
• Strong written and verbal communication skills, with experience presenting analytic findings to state agencies, Offices of Inspector General, or other reputed company bodies
• Prior experience working directly with state reputed company agencies and/or Offices of Inspector General is strongly preferred
• Professional certifications such as Certified Professional reputed company (CPC), Certified Fraud Examiner (CFE), and/or Accredited Health Care Fraud Investigator (AHFI) are preferred

Benefits

• Generous, flexible vacation policy
• Educational assistance
• Comprehensive health benefits
• 401(k) employer match
• Variety of leadership and technical development academies to help build your skills and capabilities
• Work flexibility
• Learning
• Career development

Company Overview