Healthcare Fraud Analyst (Operations Operational Analyst IV)

Medica • Minnetonka, MN

2d • Remote

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Responsible for operationalizing business and/or regulatory requirements, including project management process improvement and work related to growth initiatives and or optimization. Must be subject matter expert in focus. Performs other duties as assigned.

Requirements

• Bachelor's degree or equivalent experience in related field
• 7 years of work experience beyond degree
• Prior experience managing a vendor relationship with a product like Pre-shield
• Demonstrated ability to compile reports, conduct analysis, and prepare leadership presentations

Nice To Haves

• Investigative skills, interest, and aptitude
• Strong attention to detail and organizational skills
• Strong written and verbal communication skills
• Working knowledge of healthcare claims and billing systems

Responsibilities

• Identify efficient ways to save money by using our Healthcare Fraud Shield tool – Pre-Shield
• Collaborate with teams across technology, security, compliance, and health services to identify opportunities to create efficiency and security in member data
• Assist with coordination of investigations and suspected fraudulent billing or inflated billing

Benefits

• competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees