Senior Compliance Analyst

Job Summary

Supporting the detection of potentially fraudulent activities, the full-time Senior Compliance Analyst in the Special Investigations Unit will analyze data, conduct research, and prepare reports to mitigate fraud risk and ensure compliance with regulatory requirements while working remotely.

Key responsibilities

• Analyze large datasets to identify patterns and trends indicative of fraudulent activity
• Collaborate with auditors and investigators to prepare reports and manage quarterly CMS fraud reports
• Develop comprehensive reports summarizing analyses and recommendations for targeted audits and investigations

Required qualifications

• Bachelor's degree in business, healthcare administration, criminal justice, or a related field
• Minimum of 3 years of experience in healthcare fraud investigation or medical claims analysis
• Proficiency in data analysis tools such as Excel or Google Sheets and knowledge of statistical analysis techniques
• Experience in analyzing healthcare claims data and utilizing statistical tools for insights
• Familiarity with Medicare and Medicaid regulations related to fraud detection and prevention