Payment Integrity Analytics, Senior Analyst

Any city, TX, US, 99999 R

USD 69K-99K Senior-level Full Time

@ G...

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Found 1d ago

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

Skills/Tech-stack

Education

N/A

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Payment Integrity Analytics, Senior Analyst

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