Fraud, Waste & Abuse (FWA) Data Analyst
- Employer
- UCare
- Location
- Minneapolis, Minnesota
- Posted
- Mar 30, 2023
- Closes
- Apr 05, 2023
- Ref
- 3456
- Category
- Healthcare
- Employment Status
- Full Time
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.
UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
Rewards
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
www.ucare.org/careers/
EOE/AA
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
FRAUD, WASTE & ABUSE (FWA) DATA ANALYST
Work Location: Work from Home, In the Office or Office for Your Day
Position Description
As the Special Investigations Unit (SIU) Data Analyst, you will be responsible for the coordination and performance of data analytics for the Special Investigations Unit (SIU) team. You will serve as the hub of data mining and informatics for the SIU team. You will generate and analyze reports to detect Fraud, Waste, and Abuse (FWA). In addition, you will provide profiling and trend reports, support, and training to SIU staff with respect to data analytics, investigational cooperation with regulators and authorities and assisting management with reporting requirements.
• Collaborate with the SIU Manager to identify potential fraud, waste and abuse patterns through data analytics.
• Analyze results and reporting. Summarize and analyze findings, formulate recommendations in report format, track analysis findings, and communicate findings to SIU leadership or SIU staff.
• Coordinate and monitor SIU reporting processes for internal and external stakeholders.
• Deliver all reports in accordance with reporting schedules as dictated by DHS, CMS and UCare leadership. Prepare analysis for internal stakeholders to assist in meeting strategic and departmental goals. Prepare reports for internal and external audits, as requested.
• Design innovative analytic queries/methods that improve SIU Artificial Intelligence capabilities. Partner with Health Care Economics (HCE) to create queries.
• Design and implement new analyses and reporting to support UCare's SIU and SIU Management.
• Provide direction and clarity in the planning and development of new reporting and analytics within UCare's Compliance department/SIU.
• Develop high-level business relationships and high impact projects to drive operational initiatives and policy development recommendations. Use data analytics and review policies to identify educational opportunities for UCare's internal and external business partners and providers as preventative and corrective efforts.
• Develop and maintain a working knowledge of UCare's Data Warehouse system. This includes, but not limited to, membership, claims, providers, authorizations, and product lines.
• Address all ad-hoc data requests.
• Other projects and duties as assigned.
Education
Bachelor's degree in Data Analytics, Economics, Statistics, Data Science, Business Administration or a closely related field; demonstrated experience may be considered in lieu of degree.
Required Experience
Three years of progressive experience in health care data analytics. Demonstrated experience with financial and utilization reporting, including clinical and pharmacy analytics. Experience in completing complex analytics, defining specifications, reporting solutions and presenting findings to management, senior management and external partners. Advanced Excel experience, SQL experience is a plus.
Preferred Experience
Experience working with HealthCare Fraud. Knowledge of Medicare and Medicaid.
Experience with health plan claims and/or provider data.
Experience working with, Tableau, SAP BusinessObjects, SAS.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 3/29/2023
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.
UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
Rewards
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
www.ucare.org/careers/
EOE/AA
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
FRAUD, WASTE & ABUSE (FWA) DATA ANALYST
Work Location: Work from Home, In the Office or Office for Your Day
Position Description
As the Special Investigations Unit (SIU) Data Analyst, you will be responsible for the coordination and performance of data analytics for the Special Investigations Unit (SIU) team. You will serve as the hub of data mining and informatics for the SIU team. You will generate and analyze reports to detect Fraud, Waste, and Abuse (FWA). In addition, you will provide profiling and trend reports, support, and training to SIU staff with respect to data analytics, investigational cooperation with regulators and authorities and assisting management with reporting requirements.
• Collaborate with the SIU Manager to identify potential fraud, waste and abuse patterns through data analytics.
• Analyze results and reporting. Summarize and analyze findings, formulate recommendations in report format, track analysis findings, and communicate findings to SIU leadership or SIU staff.
• Coordinate and monitor SIU reporting processes for internal and external stakeholders.
• Deliver all reports in accordance with reporting schedules as dictated by DHS, CMS and UCare leadership. Prepare analysis for internal stakeholders to assist in meeting strategic and departmental goals. Prepare reports for internal and external audits, as requested.
• Design innovative analytic queries/methods that improve SIU Artificial Intelligence capabilities. Partner with Health Care Economics (HCE) to create queries.
• Design and implement new analyses and reporting to support UCare's SIU and SIU Management.
• Provide direction and clarity in the planning and development of new reporting and analytics within UCare's Compliance department/SIU.
• Develop high-level business relationships and high impact projects to drive operational initiatives and policy development recommendations. Use data analytics and review policies to identify educational opportunities for UCare's internal and external business partners and providers as preventative and corrective efforts.
• Develop and maintain a working knowledge of UCare's Data Warehouse system. This includes, but not limited to, membership, claims, providers, authorizations, and product lines.
• Address all ad-hoc data requests.
• Other projects and duties as assigned.
Education
Bachelor's degree in Data Analytics, Economics, Statistics, Data Science, Business Administration or a closely related field; demonstrated experience may be considered in lieu of degree.
Required Experience
Three years of progressive experience in health care data analytics. Demonstrated experience with financial and utilization reporting, including clinical and pharmacy analytics. Experience in completing complex analytics, defining specifications, reporting solutions and presenting findings to management, senior management and external partners. Advanced Excel experience, SQL experience is a plus.
Preferred Experience
Experience working with HealthCare Fraud. Knowledge of Medicare and Medicaid.
Experience with health plan claims and/or provider data.
Experience working with, Tableau, SAP BusinessObjects, SAS.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 3/29/2023
