Job Description

Resp & Qualifications

PURPOSE:
The Special Investigations Data Analyst will be responsible for investigations, analysis, and preparation of reports and investigations.

ESSENTIAL FUNCTIONS:

Responsible for importing, cleaning, transforming, validating or modeling data with the purpose of making conclusions from the data for decision-making purposes. Ensure data quality and data integrity for all reports generated by the data team.

Responsible for supporting the prevention, detection, investigation, reporting and when appropriate, recovery of money related to health care fraud, waste, and abuse across the organization, which includes generating accurate and timely analysis and reports to support the SIU initiatives to identify fraud, waste and abuse.

Present findings individually or with a group of his/her peers that cooperatively works to give SIU management and associates a synopsis of their findings

Work closely with the SIU Forensic Analyst in preparing SIU outlier reports and analysis for use by the department when determining whether to pursue an investigation and/or to provide additional information during an investigation.

QUALIFICATIONS:

Education Level: Bachelor\'s Degree in Information Systems or related quantitative field (finance, computer science, mathematics etc...).

Experience: 2 years business experience in a health care environment. working knowledge of the managed health care business, including data analysis and medical coding.

Knowledge, Skills and Abilities (KSAs)

• Possess strong math and analytical skills.
• Excellent PC skills including a working knowledge of Microsoft ACCESS and EXCEL and relational databases/SQL Server.
• Background in extracting and compiling data, creating reports, and displaying information, along with experience combining clinical and financial data.

Salary Range: $59,976 - $119,119

Salary Range Disclaimer

Salary will be based on education, location, experience, certifications, etc. In addition to your salary, CareFirst offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).

Department

Department:

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply:

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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