Note: The job is a remote job and is open to candidates in USA. CoventBridge Integrity Systems provides investigative services, technology, and expertise to help healthcare and government organizations combat fraud, waste, abuse, and operational risk. The Data Analyst II will analyze healthcare claims using statistical, data mining, and predictive analytics methods; support fraud investigations and case development; validate findings; and communicate insights to stakeholders, partners, and law enforcement.
Responsibilities
- Perform comprehensive analysis of healthcare claims data using advanced statistical and analytical methods; prepare clear, concise, and well-structured reports summarizing key findings
- Collaborate with management, investigators, and analysts to support both proactive and reactive case development efforts by fulfilling data requests
- Apply techniques such as data mining, statistical modeling, and predictive analytics to identify anomalies in Medicare/Medicaid claims; proactively generate leads and build cases from sources including CMS, OIG, fraud alerts, and various government or private referrals
- Validate analytical outputs and identify potential fraud, waste, or abuse in alignment with Medicare/Medicaid regulations, policies, and guidelines
- Communicate analytical insights effectively to internal stakeholders and external partners, including law enforcement agencies
- Respond to management requests related to CMS reporting requirements with timely and accurate data support
- Contribute to the development and delivery of training sessions for providers, beneficiaries, staff, and law enforcement on fraud, waste, and abuse detection through data analysis
- Demonstrate strong organizational skills and manage multiple tasks efficiently while adhering to strict timelines
- Ensure the integrity and security of all documentation by maintaining proper chain of custody and following confidentiality protocols
- Adhere to all required documentation standards and reporting procedures as defined by internal and external guidelines
- Perform other duties as assigned
Skills
- * Bachelor's or Master's degree in Mathematics, Statistics, Health Informatics, Data Science, or a related field
- * Minimum 2 years' experience analyzing Medicare and/or Medicaid data
- * Minimum 2 years' experience in SQL and Python
- * Working knowledge of SAS, Databricks, Snowflake, or Spark
- * Experience with libraries like Pandas, NumPy, Scikit-learn, or visualization tools like Seaborn, Matplotlib, Tableau, or Power BI
- * Strong understanding of healthcare claims, ICD codes, provider identifiers, and Medicare/Medicaid billing practices
- * Exceptional organizational, communication, and problem-solving skills
- * Bachelor's Degree in Mathematics, Statistics, Healthcare Administration, Data Science, or related discipline with preference given to MA or MS recipients, and/or relevant work experience as a data analyst
- * 2+ years of SQL or SAS development experience as well as demonstrated knowledge of healthcare and claims, or a combination of education and equivalent work experience
- * Demonstrated knowledge of various database management systems in order to input, extract or manipulate information
- * Experience working with any state Medicaid agency, Medicaid Administrative Contractor, or Unified Program Integrity Contractor
- * Experience in transitioning from SAS to more modern tools (e.g., Databricks, Snowflake)
- * Familiarity with CMS reporting and fraud detection protocols
- * Demonstrated experience and knowledge of healthcare information (health claims data; specifically, Medicare and Medicaid, ICD-9-CM and ICD-10-CM codes, physician specialty codes, pharmaceutical data, provider identifiers, etc.) is preferred
Benefits
- Remote work from a home office if not local to the Grove City, OH office
- Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
- Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
Company Overview