FWA Business Intelligence Lead

Humana • Work at Home - Kentucky, IN

6d • $117,600 - $161,700 • Remote

About The Position

The Business Intelligence Lead describes the tools, technologies, applications and practices used to collect, integrate, analyze, and present an organization's raw data to create insightful and actionable business information. The current Special Investigations Unit review process has experienced a significant increase in activity and impact, with new provider reviews rising monthly, increasing stop/void checks, and prepay denials. This role will have a significant focus on Fraud and Waste and its substantially expanded fraud detection and payment prevention efforts. Due to our fast growth, this role will lead internal and enterprise improvement projects such as operational improvements, AI integration, automation, platform implementation and Key Performance Indicators/reporting improvements.

Requirements

• Undergraduate degree
• Minimum 8 years of experience in data analysis including enhancing relational data sets for reporting and analytics
• Minimum 2 years of project leadership experience
• Experience with Fraud, Waste, and Abuse in either the healthcare or banking industry
• Advanced experience working with big and complex data sets within large organizations
• Proficiency in understanding Healthcare related data
• Proficiency in verbal/written communication to senior and executive leadership
• Download speed of 25 mbps and an upload speed of 10 mbps is recommended
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Advanced Degree
• Advanced in SQL, SAS and other data systems
• Experience with tools such as Tableau and Qlik for creating data visualizations
• Expertise in data mining, forecasting, simulation, and/or predictive modeling
• Experience creating analytics solutions for various healthcare sectors

Responsibilities

• Lead internal and enterprise improvement projects such as operational improvements, AI integration, automation, platform implementation and Key Performance Indicators/reporting improvements.
• Analyze data to solve a wide variety of business problems and create data visualizations that drive strategic direction.
• Work with cross-functional teams and translate requirements between business, project management and technical projects or programs.
• Focus on Fraud and Waste and its substantially expanded fraud detection and payment prevention efforts.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree