Payment Integrity Analytics, Senior Analyst
Tasks
- Advise on policy regulatory or statutory changes to reduce fraud risk
- Analyze audit program outcomes for systemic program integrity vulnerabilities
- Apply fraud waste abuse analytic models to Medicaid claims data
- Deliver monthly prequalified lead referral reports
- Develop recommendations for claims adjudication controls and edits
- Document analytic rationale and investigative relevance
- Ensure outputs are defensible and audit ready
- Explain methodologies and data sources to investigators
- Identify potential fraud waste abuse leads
- Present leads to Medicaid program integrity and OIG staff
- Provide feedback to analytics and data science teams on model performance and data quality
- Provide testimony or in person investigative support when required
- Recommend enhancements modifications or corrections to analytic models
- Respond to follow up questions and perform ad hoc analyses
- Support investigations with documentation and exhibits
- Translate investigative outcomes into an analytics roadmap
Perks/Benefits
- 401k employer match
- Career development academies
- Comprehensive health benefits
- Educational assistance
- Flexible vacation policy
- Leadership development academies
- Work flexibility
Skills/Tech-stack
Audit Readiness | Claims data | Claims data analysis | Data Analysis | Data Interpretation | Data Quality | Fraud Waste Abuse | Medicaid | Presentation Skills | Report Writing | SQL | Statistical Analysis
Education
N/A
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