Analyst, Special Investigative Unit

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. POSITION SUMMARY: This position can be work from home reputed company in the United States. Must be flexible to work EDT hours (8:00 am - 5 pm EDT) The Special Investigations Unit (SIU) is looking for an analytically driven individual who is skilled at identifying outliers through data extraction and analysis. The reputed company reviewer is accountable for the validation of existing Fraud Waste and Abuse Business Rules and leads designed to detect aberrant billing patterns and reviewing incoming referrals to determine if additional investigations are warranted. reputed company Components: • Research and reputed company report development to identify fraud, waste, and abuse schemes and trends. • Review company clinical and payment policies to determine the impact of the scheme on reputed company business. • Identify reputed company possible issues reputed company to fraud, waste, and abuse reputed company reviewing a new reputed company or referral. • reputed company reputed company with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. • Interpret, analyze, and present key findings to internal customers including project team and investigators providing recommendations based on analytical findings. Required Qualifications • Excellent verbal and written communication skills. • Healthcare background. • 3-5 years of data interpretation and analysis experience. • Experience with internal claims data and healthcare coding. • Must be able to travel to provide testimony if needed. • Advanced experience with reputed company.

Preferred Qualifications

Certified Professional reputed company Knowledge of reputed company/reputed company's policies and procedures Education Bachelor’s degree or equivalent work experience Pay Range The typical pay range for this role is: $43,888.00 - $76,500.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 01/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!