Senior Fraud Waste Abuse Analyst CPC or CFE - Remote jobs in United States
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Optum · 1 week ago

Senior Fraud Waste Abuse Analyst CPC or CFE - Remote

positionUnited States
timeFull-time
remoteRemote
senioritySenior Level
money$92K/yr - $164K/yr
date5+ years exp

Optum is focused on improving the flow of health data and information to create a connected system. The Senior Fraud Waste and Abuse Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims, while also developing algorithms to support program integrity.

EducationHealth CareMedicalPharmaceutical

Responsibilities

Write simple to complex SQL statements to extract data for client inquiry and research
Utilize production reports to perform research and assess quality of overall data
Analyze and interpret data to identify FWA trends and patterns within claims data
Applies creative and analytical thinking to uncover and resolve complex fraud, waste, and abuse patterns
Engage with clients to triage and manage incoming operational inquiries and tasks
Identifies innovative approaches to resolve non-standard problems and deliver effective outcomes
Interface professionally with data engineers, software engineers and other development teams
Troubleshoot client operational issues quickly and comprehensively
Support, train and mentor fellow analysts and developers
Influences and provides input to improvement of operational processes

Qualification

Certified Professional Coder (CPC)Certified Fraud Examiner (CFE)Advanced SQL queriesData analysis experienceHealthcare claims experienceExcel proficiencyStatistical analysisData mining experienceRally experienceMedicaid policy knowledgeHealthcare claim adjudicationSoft skills

Required

Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
5+ years of fraud, waste and abuse data mining experience
5+ years of experience writing advanced SQL queries
4+ years of data analysis experience working with database structures
4+ years of healthcare claims experience
Proficiency with excel & visualization tools
Proficient in research, interpreting, and analyzing diverse and complex data, and assessing data quality
Intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point
Ability to travel 10%

Preferred

Experience with statistical analysis of data
Experience with Rally
Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
Knowledge of healthcare claim adjudication systems
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Benefits

A comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

Company

Optum

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Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
dateFounded in 2011
location
Eden Prairie, Minnesota, USA
people-size10001+ employees
web-link
https://www.optum.com/

Funding

Current Stage
Late Stage

Leadership Team

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Daniel Castillo
Chief Executive Officer, Optum Care Delivery
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J
Jay Green
Chief Financial Officer
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