IEHP-posted 3 months ago
$71,572 - $93,038/Yr
Full-time • Mid Level
Rancho Cucamonga, CA
Religious, Grantmaking, Civic, Professional, and Similar Organizations

The Special Investigations Unit (SIU) Intelligence Analyst is responsible for providing proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs. This role bridges data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads and escalate high-impact patterns for formal investigation. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

  • Provide proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse.
  • Conduct data mining, statistical trend analysis, and anomaly detection.
  • Validate leads and escalate high-impact patterns for formal investigation.
  • Bachelor's degree in Criminal Justice, Data Science, Healthcare Administration, Statistics, Business Administration, Public Health, or a related field from an accredited institution.
  • Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance.
  • Experience with SQL and Power BI.
  • Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing.
  • Advanced SAS Programmer certification.
  • Experience preferably in managed care.
  • Strong preference for experience in fraud investigations, payment integrity, or compliance.
  • Prior experience in a health plan, government program, or investigatory agency SIU.
  • Experience with SAS, Tableau, or other data visualization tools.
  • Competitive salary
  • Hybrid schedule
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account - Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
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