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Health Insurance Fraud Analyst : 72004151
Location:
Tallahassee, FL
Description:
Requisition No:826110 Agency: Management Services Working Title: HEALTH INSURANCE FRAUD ANALYST : Pay Plan: Career Service Position Number: Salary: 65, : 75, Posting Closing Date: 04/30/2024 Total Compensation EstimatorTool Health Insurance Fraud Analyst Division of State Group Insurance State of Florida Department of Management Services This position is located in Tallahassee, FL Position Overview and Responsibilities: The selected candidates will join the Division of State Group Insurance, Program Integrity Unit as Health Insurance Fraud Analysts and will perform data mining and investigative activities to identify fraud, waste, or abuse in claims data within our program. Additionally, these positions will provide analytical and consultative support related to data integrity and quality within our program. Through data exploration, the Health Insurance Fraud Analysts will identify outliers and trends based on relevant fraud, waste, and abuse topics; design and implement algorithms to effectively data:mine within various types of claims data utilizing a variety of software applications; compile research, data analysis, and results into comprehensive reports for unit investigations.Specific responsibilities of this position will include, but not be limited to, the following: : Identify suspicious patterns within claims data and other sources by applying your knowledge of heath care coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies and relevant laws.: In collaboration with the team and the Program Integrity Unit Manager, draft investigative work plans and develop case strategies based upon analysis.: Organize data and prepare a written summary of investigative steps, conclusions, recommendations.: Prepare clear and concise investigatory reports and statistical/financial analysis to support findings of potential fraud, waste, and abuse.: Present case to agency leadership, law enforcement and/or regulatory agencies.: Utilize a variety of complex applications, tools, and processes to successfully work within and between very large data sets.: Proactively identify new and emerging medical and pharmacy fraud schemes through research and use of the various software applications.: Work with the team to design data analysis strategies to identify potential areas for a focused investigation.: Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Knowledge, Skills, and Abilities: : Experience in auditing, data analysis, or fraud detection.: Knowledge of claims processing and medical terminology.: Experience in creating, supporting, or writing reports, business correspondence and technical documents.: Experience using Healthcare:related software applications including data quality.: Experience in quality assurance, and or investigations.: Ability to multi:task and complete multiple project assignments simultaneously.: Demonstrates exemplary organizational and prioritization skills.: Strong analytical and problem:solving skills.: Displays a high level of initiative and is action oriented.: Careful attention to detail and accuracy in work products; critical thinking and intellectual curiosity.: Ability to work independently with self:initiative and limited direction yet be collaborative and team minded.: Ability to extract data of multiple formats, analyze, and document results.: Ability to work with a variety of stakeholders in sometimes difficult situations while maintaining professionalism.:Advanced Excel skills required plus in:depth knowledge and proficiency with MS Power BI or similar software. Minimum Qualifications: : Four years of professional work experience related to the duties and r
Industry:
Insurance
Posted:
May 1 on Tip Top Job
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