Senior Analyst, Healthcare Fraud, Waste and Abuse

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $97k - $110k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Lucet

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lucet is a tech-enabled behavioral health company that combines human care teams and digital tools to connect individuals to timely, in-network mental health and substance-use care. It partners with health plans, employers, providers, and members through portals (employer/HR, member, provider, partner) and services such as EAP, care navigation, and provider resources to optimize access, quality, and value-driven behavioral healthcare.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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