Optum is looking to solve the problem of fraudulent activities within Medicaid claims by identifying, analyzing, and preventing fraud, waste, and abuse in state Medicaid programs.
Requirements
- 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
- Proven intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point.
- Industry certifications: Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
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
- 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
Other
- Ability to travel 10%
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
- For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
- 5+ years of experience
- Bachelor's degree not explicitly mentioned but may be required
