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Investigative Data Analyst
Ref No.: 18-08744
Location: Philadelphia, Pennsylvania
The primary purpose of the job is to:

The Investigative Data Analyst will provide data analysis support to the SIU.
Conduct data mining efforts to identify outliers and trends based on relevant fraud, waste, and abuse topics and media, state, and federal press releases to identify any potential impact and/or exposure to the enterprise to develop cases and increase the proactive response of the SIU.
Provide investigative support to the SIU in the area of claims processing, operations, etc. and act as a subject matter expert for the SIU within area of the job responsibilities.
Complete complex data requests to provide assistance to the SIU and to assist with completing requests from law enforcement, state, and other agencies.
Responsible for initiating and coordinating the timely and accurate transfer of claims for reprocessing and recovery of overpayments identified as a result of fraud, waste, and abuse.
Required to update the case management tracking system to document the overpayment recoveries and report on activity on a weekly/monthly/quarterly basis as directed by SIU Management.
Within area of job responsibilities, assist with the development and implementation of SIU processes. Responsible for the building of queries in support of SIU operations and the maintenance of data integrity for SIU systems and processes.
Assist with the development of reports in order to meet required company and state reporting of SIU activities. Completes reports of analysis, data mining, etc. for presentation to SIU management and Program Integrity leadership.
Attend and participate in SIU related meetings and required trainings.
Demonstrates and supports commitment to corporate and department goals and missions.
Maintains the highest level of confidentiality regarding SIU operations.
Willingness to take on additional tasks or incorporate changing roles in order to meet the current business needs of the department.

Major Accountabilities:
• Ability to extract data, analyze, and document results
• Compile data through the use of computer-based applications; gathering, compiling, modeling, validating, and analyzing data needed by the SIU
• Experience working with large data sets
• Analyze, review, forecast, and trend complex data
• Review the analysis and interpretation of other’s work
• Successfully manage numerous large and complex analytical projects successfully and in a timely manner
• Proficiency in the research, interpretation, and application of government rules/regulations/policies
• Careful attention to detail and accuracy in work products
• Ability to view concepts from a variety of angles
• Demonstrate critical thinking and intellectual curiosity

1 to 3 years Analyst/Investigation
• In-depth knowledge of claims processing and medical terminology required
• Knowledge and experience in Medicaid/Medicare, preferably regarding FWA
• Experience in analyzing claims, encounter, or other patient data preferred
• Healthcare or Managed Care experience required
• In-depth knowledge of Microsoft Office and PC applications in a windows based environment required
• In-depth knowledge of MS Access, SAS
• Professional written and oral communications required
• Possesses strong analytical and problem solving skills
• Displays a high level of initiative and is action oriented