Senior Analyst, Healthcare Fraud, Waste and Abuse

🕒 2 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $97.000 - $110.000 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

👻 Score fantasma 0%

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Lucet

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

A Lucet é uma empresa de saúde comportamental habilitada por tecnologia que combina equipes de assistência humana e ferramentas digitais para conectar indivíduos a cuidados de saúde mental e uso de substâncias, pontualmente e dentro da rede. Ela faz parcerias com planos de saúde, empregadores, prestadores e membros por meio de portais (empregador/RH, membro, prestador, parceiro) e serviços como EAP (Programa de Assistência ao Empregado), navegação de cuidados e recursos para prestadores, para otimizar o acesso, qualidade e atendimento de saúde comportamental orientado por valor.

Descrição

• Serve as a business consultant to the organization by providing reports and analysis supporting Program Integrity and Fraud, Waste & Abuse prevention • Translate evaluation questions into analytic plans • Construct analytic datasets • Produce appropriate data summaries • Conduct valid data comparisons and statistical tests • Lead and expand reporting and analytics programs to generate insights and drive actions supporting FWA prevention • Perform detailed claims trend and drill-down analyses to identify actionable FWA risks across member and provider populations and cost categories • Partner with clinical strategy teams to define intervention and comparison cohorts • Develop valid performance measures and ensure appropriate use of enterprise data • Profile member populations and identify opportunities for new service offerings • Project savings through multivariable analysis • Identify cost-saving opportunities through analysis of care utilization, practice patterns, negotiations, and contract performance • Recommend improvements to reduce cost of care • Evaluate the financial impact of contracts, RFPs/RFIs, and operational initiatives • Provide data-driven recommendations and reporting to support management decision-making

🎯 Requisitos

• Bachelor's Degree • 5+ years of experience in a similar role at healthcare payer or provider organization • Familiarity with common statistical methods including regression, propensity matching, and analysis of variance • Proficiency in database query language (e.g. SQL, SAS) • Experience with Python or R for data analysis, extraction, and manipulation • Experience with Tableau or PowerBI for data visualization • Experience with analytic automation, such as scripting or macros • Experience with enterprise data warehouse and commercial/Medicare/Medicaid claims data • Ability to read, analyze and interpret technical materials and financial data • Ability to present information in a small group setting with internal and external customers • Ability to perform complex arithmetic and intermediate algebra to set up spreadsheets and reports • Advanced graphical skills for creating readily understandable reports • Ability to pass background check upon hire and throughout employment, including criminal, employment, education, healthcare sanctions, prohibited parties, sex offender registry, and 10-panel drug screening • High-speed internet service with minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds • Ability to work from a quiet workspace with minimal background noise • Strong analytic and data management skills • Strong oral and written communication and presentation skills • Ability to work independently and as part of a team • Ability to work effectively with individuals at all organizational levels • Ability to appropriately scope and execute evaluation and analysis work • High level of integrity and ethical standards • Ability to identify compliance irregularities • Excellent communication and interpersonal skills

🏖️ Benefícios

• Annual performance-based, discretionary incentive • Medical, dental, and vision coverage • 401(k) with competitive employer match • Company-paid life and disability insurance • Paid parental leave and wellbeing incentives • Generous paid time off, including volunteer time • Flexible spending accounts for healthcare and dependent care • Professional development opportunities and tuition reimbursement • Remote work flexibility (role-dependent) • Company-provided equipment • Opportunity for meaningful growth, both personally and professionally