Fraud Waste Abuse - FWA - Senior Data Analyst - Remote

UnitedHealth Group • St. Louis, MO

2d • Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Fraud, Waste, and Abuse (FWA) Senior Data Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims. You will be working with a State Government Product and Data Mining team. Your primary responsibility will be to assist in the development and deployment of algorithms designed to support program integrity across various platforms and states plus support our fraud and abuse detection product and services.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

• Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
• 5+ years of fraud, waste and abuse data mining experience
• 5+ years of experience writing advanced SQL queries
• 4+ years of data analysis experience working with database structures
• 4+ years of healthcare claims experience
• Proficiency with excel & visualization tools
• Proficient in research, interpreting, and analyzing diverse and complex data, and assessing data quality
• Intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point
• Ability to travel 10%25

Nice To Haves

• Experience with statistical analysis of data
• Experience with Rally
• Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
• Knowledge of healthcare claim adjudication systems

Responsibilities

• Write simple to complex SQL statements to extract data for client inquiry and research
• Utilize production reports to perform research and assess quality of overall data
• Analyze and interpret data to identify FWA trends and patterns within claims data
• Applies creative and analytical thinking to uncover and resolve complex fraud, waste, and abuse patterns
• Engage with clients to triage and manage incoming operational inquiries and tasks
• Identifies innovative approaches to resolve non-standard problems and deliver effective outcomes
• Interface professionally with data engineers, software engineers and other development teams
• Troubleshoot client operational issues quickly and comprehensively
• Support, train and mentor fellow analysts and developers
• Influences and provides input to improvement of operational processes

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees