Note: The job is a remote job and is open to candidates in USA. Optum Insight is improving the flow of health data and information to create a more connected system. The Fraud, Waste, and Abuse (FWA) Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims.
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
- Engage with clients to triage and manage incoming operational inquiries and tasks
- Identifies innovative approaches to resolve non-standard problems and deliver effective outcomes
- 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
- Influences and provides input to improvement of operational processes
- Work is self-directed, less structured, more complex issues
- Function well within a matrix organization (E.g. - supporting multiple leaders)
- Proficient in research, interpreting, and analyzing diverse and complex data, and assessing data quality
- Proficiency with excel & visualization tools
- Intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point
Skills
- 5+ years of experience writing advanced SQL queries
- 5+ years of fraud, waste and abuse data mining experience
- 5+ years of intermediate to advanced proficiency in Microsoft Excel, Word, Teams, PowerPoint, and Outlook
- 4+ years of data analysis experience working with database structures
- 4+ years of healthcare claims experience
- Industry certifications: Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
- Experience with statistical analysis of data
- Experience with Rally
- Experience with data visualization tools and report interpretation
- Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
- Knowledge of healthcare claim adjudication systems
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
Company Overview