Fraud, Waste & Abuse Lead Analyst
New
J
JobgetherHealthcare
Fully remote work opportunity across the United States.Full-TimeLead
Salary$104,000 - $143,000, depending on location, skills, experience, education, and qualifications.
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Job Details
- Experience
- 8+ years of progressive experience in technical data analysis roles.
- Required Skills
- SQLData AnalysisData MiningMachine LearningMicrosoft Power BIMicrosoft Excel
Requirements
- Bachelor’s degree in a related field or equivalent combination of education and experience.
- 8+ years of progressive experience in technical data analysis roles.
- 2+ years of experience leading projects, initiatives, or cross-functional workstreams.
- 2+ years of experience reviewing claims related to fraud, waste, and abuse.
- Experience working with claims platforms and understanding claim processing operations.
- Advanced proficiency with Microsoft Office applications, including Excel, Access, Word, and PowerPoint.
- Strong analytical and problem-solving skills with the ability to interpret complex datasets.
- Excellent written and verbal communication skills, including experience presenting recommendations to senior and executive leadership.
- Ability to manage multiple priorities and operate effectively in a complex business environment.
- Advanced proficiency with SQL, SAS, or other analytical and data management platforms is preferred.
- Experience developing dashboards, visualizations, and reporting solutions using tools such as Power BI is preferred.
- Master’s degree in Data Analytics, a quantitative discipline, or related field is preferred.
Responsibilities
- Lead complex analytics, reporting, and data mining initiatives focused on identifying healthcare fraud, waste, and abuse risks.
- Coordinate AI and machine learning projects designed to improve proactive risk detection and mitigation capabilities.
- Analyze claims data, financial trends, and operational information to uncover patterns, risks, and opportunities for improvement.
- Develop and maintain reporting solutions, dashboards, and analytical tools that support strategic decision-making.
- Partner with business stakeholders, data science teams, and operational groups to translate insights into actionable strategies.
- Review claims associated with fraud, waste, and abuse and provide recommendations to address identified risks.
- Serve as a trusted advisor to leadership by communicating trends, findings, and mitigation opportunities.
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