Perform data mining of internal systems to detect claims and billing patterns relevant to specific investigations. Collect and organize data for timely submission to regulatory and law enforcement authorities.
Conduct research using publicly available and subscription-based databases; maximize the utilization of web-based resources to advance investigations.
Prepare charts, spreadsheets, and other visual aids for presentations to management, counsel, and law enforcement. Create and modify reports/queries on SIU activities.
Identify and analyze questionable patterns and other red flags (Claims, Premium, or Provider) in order to identify documents for further review by an investigator.
Foster a positive working relationship and regular communications between the SIU and other departments, primarily Claims, Client Services, Premium Audit, Medical Management/Bill Review, and Data Analytics.

Education: High School Diploma or equivalent certificate required. Associate's or Bachelor's degree from an accredited college or university preferred.
Experience: Minimum of 2 years of related experience and/or combination of training and experience in data analytics, and extensive experience with a variety of social media platforms, required.
Math and Reasoning Ability: Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, graph, or schedule form. Ability to apply concepts such as addition, subtraction, multiplication, division, fractions, percentages, ratios, and proportions to practical situations. Ability to derive appropriate conclusions and apply on the job.

Background and Data Intelligence Analyst

Key skills