Senior Compliance Analyst, Special Investigations Unit

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Analyze large datasets to identify patterns, trends, and anomalies indicative of fraudulent activity utilizing advanced analytical techniques and tools to support development of investigative leads. • Collaborate with auditors and investigators to prepare reports and provider education letters. • Manage quarterly CMS fraud reports and regulatory memos to determine if Devoted has any FWA exposure/ or risk. • Intaking and triaging referrals related to fraud, waste, and abuse, inclusive of internal and external referrals. • Develop comprehensive reports summarizing analyses and trends with recommendations for targeted audits and investigations. • Work closely with internal departments (e.g.,Payment Integrity, Claims, Clinical Escalations) to share findings and coordinate on concept development and FWA scheme targeting criteria. • Develop educational materials for internal and external stakeholders (e.g., providers, members, employees). • Conduct quality assurance (QA) review of case documentation. • Attend and participate in SIU and PI status meetings (weekly, bi-weekly, quarterly, ad-hoc). • Stay updated on relevant laws, regulations, and industry standards related to healthcare fraud and contribute to compliance efforts.

🎯 Requirements

• Bachelor’s degree in business, healthcare administration, criminal justice, or a related field. • Minimum of 3 years of experience in healthcare fraud investigation, medical claims analysis, or a related field. • Proficiency in data analysis tools (e.g.,Excel/Google Sheets) and knowledge of statistical analysis techniques. • Strong analytical and problem-solving skills, with the ability to interpret complex data and draw actionable insights. • Excellent verbal and written communication skills, with the ability to present findings clearly to diverse audiences. • High level of attention to detail and accuracy in data analysis and reporting.

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles • Parental leave program • 401K program • And more....