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We’re looking for a Special Investigation Unit Analyst to support The Health Plan line of business. Someone who’s ready to grow with our company. In this position you will be responsible for applying their knowledge and experience to support Special Investigation Unit's (SIU) regulatory compliance, analytical needs, investigative support, and other business needs. Represents the business area in strategic planning activities and provides recommendations based on best practices, benchmarking, data analysis and forecasting. Assists with the implementation, operation, and oversight of operational fraud and analytical applications, organizing internal and external data, responds to requests for information, and communicates recommendations to SIU management. Provides oversight for research, design, build, testing, deployment, analysis, administering, and maintaining environments.
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Job Duties & Responsibilities
• Ensures internal and external reporting is in compliance with relevant requirements
• Responds promptly and appropriately to internal and external questions/requests.
• Attends regulatory meetings to stay current on relevant regulatory requirements.
• Completes weekly, monthly, quarterly, yearly, and ad-hoc reporting needs.
• Utilizes departmental tools (schedules, meeting minutes, budget, standardized emails, and agendas) to maintain consistent, quality communication with customers.
• Facilitates internal communication and acquisition of needed data to compile and submit required reports.
• Monitors and ensures compliance with reporting submission deadlines and content of reports.
• Ensures regulatory order/requests for information management, oversight, documentation, and facilitating internal and external delivery/communication/fulfillment.
• Acts as the SIU liaison for internal and external entities including regulators, providers, members, internal departments, and other external entities.
• Maintain and operate, the operational fraud and analytical applications.
• Oversees the SIU fraud hotline, electronic mail referrals, and paper referrals that come into the SIU, additionally providing miscellaneous investigative support.
• Makes recommendations during continuous performance management processes and acts as a resource for the establishment of new projects.
Skills & Requirements
• Required High School Diploma or GED
• Preferred bachelor's degree Project Management, Business Management, Healthcare Management, Criminal Justice
• Preferred Certified Professional Coder (CPC) or similar
• Preferred Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering (AML), and Fraud Professional (CAFP) are advantageous
• Required 6 years Managed Care Organization Experience
• Previous 3 years Prior SIU Analyst, SIU Investigator, or equivalent experience
Please note: This is not a law enforcement, security officer or national security related position
Additional Note: This is a hybrid role, not a fully remote opportunity
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