DescriptionThe Analyst is responsible to support investigations, to provide the necessary information and comprehensive reports. Additionally, the Analyst is responsible to provide intake, as well as track, create and/or provide key metrics on investigations and overall department performance. Develops and utilizes a wide variety of research and transaction monitoring tools. Responsible to prepare various regulatory and analytical reports.
Will work with the director and team to prevent, deter and identify unlawful or inappropriate practices by processing all referrals timely through the intake and triage procedural requirements/systems. Helps to ensure timely review and initiation of high risk cases and reports case data to appropriate agencies/regulatory bodies as directed by leadership.
The Analyst will trend data to identify potential opportunities for case leads: aid in design data analysis strategies to identify focused investigations. Analyze data, conclusions and summarize into quality indicator values. Develop reports concerning identification of exposure or risks to SH; and suggest ways to mitigate these, improve operations, focus training efforts, allocate appropriate resources or modify policies and procedures.
Bachelor's degree from an accredited college or university in Business, Finance, Statistics or closely related field required or equivalent education/experience.
• Strong internship or work experience with demonstrated excellence in producing exceptional analytic products required.
• 3-5 years of demonstrated excellence in producing exceptional analytic products in the area of high risk investigations, intelligence, or similar operations with the demonstrated ability to transfer skills to multiple functional areas preferred.
• 2-3 years managed care, insurance, health care administration experience and related experience working in an environment where high risk investigations are conducted preferred.
• 2-3 years of investigatory, data analysis or auditing experience required.
Skills and Knowledge
• Strong analytical and problem-solving skills combined with excellent verbal and written communication skills.
• Strong skills in MS Office, Excel, Access, Outlook, Word, PowerPoint, etc.
• Demonstrated ability to maintain clear documentation of investigations and corrective action plans that is clear, accurate, complete and easily understandable to stakeholders.
• Must be highly organized and detail-oriented combined with excellent time management skills.
• Strong interpersonal skills.
• Ability to follow through, meet deadlines, anticipate requirements and build relationships.
• Must be able to work collaboratively in a team environment with minimal supervision.