Senior Analyst, Healthcare Fraud, Waste and Abuse

Lucet • ,

16h • $97,000 - $110,000 • Remote

About The Position

The Sr Analyst, Healthcare Fraud, Waste and Abuse will be a business consultant to the rest of the organization in providing reports and analysis to support Lucet’s Program Integrity and Fraud, Waste and Abuse prevention. In addition, the analyst is responsible for translating evaluation questions into analytic plans, constructing analytic datasets, producing appropriate data summaries, and conducting valid data comparisons and statistical tests.

Requirements

• Bachelor's Degree
• 5+ years of experience in a similar role at healthcare payer or provider organization
• Familiar with common statistical methods including but not limited to regression, propensity matching, and analysis of variance
• Proficiency in database query language (e.g. SQL, SAS). Other experience with the use of software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau, PowerBI) and analytic automation (e.g. scripting, macros)
• Experience with enterprise data warehouse and commercial/Medicare/Medicaid claims data
• Ability to read, analyze and interpret technical materials and financial data
• Must be able to present information in a small group setting with internal and external customers
• Ability to perform complex arithmetic and intermediate algebra to set up spreadsheets and reports
• Creates reports using advance graphical skills which can be quickly understood by the customer
• Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.
• Practical problem-solving abilities, i.e. the ability to formulate hypotheses, test options and move forward in a fast-paced environment.
• Strong analytic and data management skills
• Strong oral and written communication and presentation skills
• Ability to work both independently and as part of a team is essential
• Ability to work well with individuals at all levels within the institution
• Ability to appropriately scope and execute evaluation and analysis work
• Responsible with a high level of integrity and ethical standards
• Intuitive nature to identify compliance irregularities
• Excellent communication and interpersonal skills, with the ability to collaborate across teams

Responsibilities

• Lead and expand reporting and analytics programs to generate insights and drive actions supporting Program Integrity and Fraud, Waste & Abuse (FWA) prevention.
• Perform detailed claims trend and drill-down analyses to identify actionable FWA risks across member/provider populations and cost categories.
• Partner with clinical strategy teams to define intervention and comparison cohorts, develop valid performance measures, and ensure appropriate use of enterprise data.
• Serve as a population health consultant by profiling member populations, identifying opportunities for new service offerings, and projecting savings through multivariable analysis.
• Identify cost-saving opportunities through analysis of care utilization, practice patterns, negotiations, and contract performance, while recommending improvements to reduce cost of care.
• Evaluate the financial impact of contracts, RFPs/RFIs, and operational initiatives, providing data-driven recommendations and reporting to support management decision-making.

Benefits

• Annual compensation between $97,000 - $110,000, PLUS an annual performance-based, discretionary incentive.
• Comprehensive health benefit options: Medical, dental, and vision coverage
• 401(k) with competitive employer match
• Company-paid life and disability insurance
• Paid parental leave and wellbeing incentives
• Generous paid time off, including volunteer time
• Flexible spending accounts for healthcare and dependent care
• Professional development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior