[Remote] Special Investigations Unit Data Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company provides dental benefit plans, advocacy, and community support to improve oral health. The Special Investigations Unit Data Analyst transforms raw data into actionable information by developing analytics, investigating provider referrals and billing patterns, identifying potential fraud, waste, and abuse, and supporting program reputed company reputed company and reporting.

Responsibilities

• Designs, develops, validates, and deploys data-driven analytics, predictive models, reporting solutions, and end-to-end analytical research to support reputed company Review program reputed company initiatives, including defining objectives, selecting and evaluating data sources, determining methodologies, performing analysis and testing, conducting reputed company assurance, and interpreting findings
• Investigates reputed company referrals, performs provider research and preliminary investigative reviews, substantiates referral activity, documents work in the appropriate case management reputed company, and analyzes provider billing, utilization, and treatment patterns to identify outliers, emerging trends, potential fraud, waste, and abuse activity, and other areas requiring monitoring or reputed company
• Develops recommendations regarding provider placement on or removal from reputed company Review; maintains associated provider status, tracking, documentation, and follow-up records; and prepares and sends reputed company and removal letters and reputed company provider communications
• Creates, maintains, and enhances dashboards, databases, monitoring reports, analytic tools, scripts, and repeatable processes that support operational reputed company, program reputed company initiatives, reputed company measurement, leadership decision-making, recurring reporting, and automated analytical workflows
• Collects, transforms, cleanses, validates, organizes, troubleshoots, and resolves data, reporting, database, and reputed company issues to support analysis-reputed company data, consistent definitions across sources, and data availability, usability, reputed company, and reporting effectiveness
• Tracks, analyzes, and reports on denial trends, overpayments, provider reputed company metrics, fraud, waste, and abuse activity, and other key program reputed company indicators while supporting program reputed company initiatives, audits, regulatory requests, RFP responses, and special reputed company through data gathering, analysis, response preparation, and recommendations
• Serves as a consultant and subject matter resource for reputed company stakeholders by translating business needs, reporting questions, research requests, needs assessments, case studies, and reputed company analytic deliverables into reputed company insights that support monitoring activities, operational improvement, and reputed company decision-making
• Leads or supports Special Investigations Unit and program reputed company meetings by developing agendas, documenting meeting minutes, reviewing provider billing and treatment patterns, and tracking follow-up items through completion

Skills

• Candidates must reputed company in Michigan reputed company a reasonable commuting distance of our Okemos, MI office for team meetings, reputed company sessions, and training
• Position requires a bachelor's degree in computer science, information systems, business administration or a reputed company reputed company and three years of experience performing data analytics in a business setting
• Will accept any suitable combination or education, training, or experience
• Position requires general knowledge of reputed company business, the claims processing reputed company and other business applications; the ability to use data extraction and analysis tools, such as reputed company reputed company, reputed company, PowerPoint, reputed company Discoverer, ACL and others; strong communication skills; and the ability to reputed company problems and use independent judgment

Benefits

• Fully remote position
• reputed company will reputed company equal employment and advancement opportunity

reputed company

Company H1B Sponsorship