Data Analyst II - Healthcare

CoventBridge Group is a global leader in full-service investigations, and they are seeking a Data Analyst II to detect, analyze, and report patterns of healthcare fraud, waste, and abuse. The role involves performing in-depth evaluations of potential fraud cases and translating analytic findings into actionable insights for various stakeholders.

Responsibilities:

• Work with management, investigators, and the data team to provide key statistical research, analytics, and reporting functions for innovative case development support and to fulfill health plan client and/or law enforcement data requests
• Utilize data analysis techniques such as data mining, statistical modeling, predictive modeling, etc. to detect aberrancies in health plan claims data, and proactively seeks out and develops leads and cases received from a variety of sources including a health plan client, CMS, OIG, fraud alerts, and referrals from government and private sources
• Communicate effectively with internal and external stakeholders
• Validate analytic results and identify potential fraud, waste and/or abuse situations in violation of private, state, and/or federal laws, guidelines, policies, and/or regulations
• Support management requests for client reporting requirements
• Prepare, develop, and participate in provider, law enforcement, or staff training as related to health plan insurance products including but not limited to Commercial, Medicare, Medicaid, ACA/Exchange, FEHB, and Tricare fraud, waste and abuse data analysis
• Maintain chain of custody on all documents and follow all confidentiality and security guidelines
• Create dashboards and visualizations in Tableau, Power BI, or Sigma to communicate findings
• Experience working in an enterprise analytics platform
• Perform other duties as assigned and agreed upon
• Write efficient, production-quality code in Python, R, and SQL for data cleaning, transformation, and modeling

Requirements:

• Bachelor's degree in Mathematics, Statistics, Healthcare Administration, Data Science, or related discipline with preference given to MA or MS recipients, and/or relevant work experience as a data analyst (Or similar position)
• 3+ years of experience analyzing healthcare claims data in fraud, waste, and abuse investigations
• Experience and knowledge of healthcare information (health claims data; specifically, ICD-9-CM and ICD-10-CM codes, CPT, HCPCS, DRG, 837P, etc.) is required
• Strong background in healthcare claim analytics
• Deep understanding of fraud, waste and abuse schemes
• Ability to translate analytic findings into actionable insights for investigators, clients, and stakeholders
• Effective communication skills (verbal and written) to interpret data outcomes
• High proficiency level with MS Word and Excel
• Proficiency with database and analytic programming languages such as SQL, Python, R and/or other applications to perform diverse types of data analysis and/or data science
• Strong critical thinking and problem-solving skills
• Strong organizational skills and the ability to effectively manage workload within the established timelines
• Demonstrated knowledge of various database management systems in order to input, extract or manipulate information
• Understanding of healthcare claims processes- solid understanding of health claims fields, claim types, payers, reimbursement models and regulatory requirements
• Comfortable with utilizing AI assisted development tools
• Experience with GitHub, GitLab, or other Git technology
• Experience working in an enterprise analytics platform
• Write efficient, production-quality code in Python, R, and SQL for data cleaning, transformation, and modeling
• Experience with data visualization tools such as Tableau, Power BI, or Sigma is a plus
• Knowledge of Medicare and Medicaid rules and regulation is a plus