Transform healthcare by identifying and preventing Fraud, Waste and Abuse activities at Blue Cross Blue Shield of MA
Requirements
- Proficiency in Excel, Access, Word, PowerPoint and SQL
- Programming experience in SAS, R, Python, or similar analytical languages preferred
- Experience with data visualization tools (Tableau, Power BI)
- Knowledge of cloud-based analytics platforms (AWS, Snowflake)
- Understanding of machine learning concepts and algorithms with ability to interpret model outputs
- Experience working with large structured and unstructured data sets
- Working knowledge of health insurance claims coding, including CPT, HCPCS, ICD-10, and DRG coding
Responsibilities
- Identify new and emerging fraud schemes using advanced analytics tools available to FIP
- Use a data-driven approach to inform decision-making, analyze data solutions and reliability, and identify opportunities for optimization and improvement
- Understand machine learning concepts and collaborate with data science teams to interpret model outputs and fraud scores
- Independently generate potential fraud leads for investigation or referral to appropriate internal business areas
- Apply expertise in data mining, data analysis and the presentation of data to support analytic projects
- Create reports, insights and analytics in support of the business
- Constructs and applies statistical and/or financial models to support strategic initiatives
Other
- Bachelor’s degree in a relevant field such as healthcare or data analytics
- At least five years business experience
- Four years’ experience in investigation/detection, data analytics or a related field that demonstrates expertise in reviewing, analyzing/developing information and making appropriate decisions
- Excellent written and verbal skills, with the ability to clearly and concisely present issues, analytical planning, and recommendations in verbal, written and presentation formats across all levels of the organization
- Ability to prioritize projects to meet scheduled deadlines
