Ombudsman - Mission Success (Fraud Analytics & Program Integrity)
1MJ BALTIMORE MD (TAX JURISDICTION - BALTIMORE COUNTY), United States
USD 105K-231K Senior-level Full Time
Tasks
- Analyze fraud waste and abuse patterns in healthcare claims
- Analyze root causes of complaints appeals and fraud issues
- Apply machine learning anomaly detection and predictive analytics
- Identify systemic vulnerabilities leading to fraud waste or abuse
- Integrate multi source data to uncover fraud networks
- Provide executive briefings on fraud risks mitigation strategies and performance
- Recommend systemic fixes to reduce improper payments
- Resolve patient provider and stakeholder concerns
- Support audits investigations and continuous monitoring
- Support case development with investigative audit and compliance teams
- Support compliance with federal healthcare regulations privacy requirements and program integrity standards
- Track fraud trends complaint patterns and operational risks with dashboards
Perks/Benefits
- Continuing education
- Family support benefits
- Flexible time off
- Healthcare benefits
- Learning and development
- Retirement benefits
- Wellness benefits
Skills/Tech-stack
Anomaly Detection | Business Intelligence | Cause analysis | Compliance Management | Dashboard Reporting | Data Privacy | Data analytics | Data integration | Executive Communication | Fraud Detection | Improper Payment Reduction | Machine Learning | Network Analysis | Predictive Analytics | Predictive Modeling | Root Cause Analysis | Root cause | Stakeholder management | Tableau
Education
Bachelor of Engineering | Bachelor of Science | Master of Science
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