SIU Intelligence Analyst
IEHP
SQLTableau
Intelligence Analyst
IEHP
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $71,573 - $93,038 per year
Job Level
Mid-LevelSenior
Tech Stack
SQLTableau
About the role
- Perform advanced data analytics and intelligence gathering to identify emerging fraud trends, organized schemes, and high-risk providers or claims
- Conduct data mining and exploratory analytics to identify emerging fraud schemes, suspicious billing patterns, and provider/vendor anomalies
- Provide actionable intelligence, lead packages, and data visualization to SIU investigators in support of fraud, waste, and abuse (FWA) investigations
- Evaluate large datasets, including claims, medical records, provider enrollments, and utilization to uncover outlier behavior and systemic vulnerabilities
- Maintain SIU case documentation and track lead disposition to support audits and ensure regulatory readiness
- Build and maintain dashboards, reports, and risk detection models to identify and monitor healthcare fraud, waste, and abuse trends
- Prepare concise intelligence reports, presentations, and briefings for SIU leadership, Legal, Compliance, and operational teams
- Cross-functional collaboration with IEHP’s Business Units to validate lead data and support program improvement
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful
Requirements
- Bachelor’s degree in Criminal Justice, Data Science, Healthcare Administration, Statistics, Business Administration, Public Health, or a related field from an accredited institution required
- Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred
- Advanced SAS Programmer certification preferred
- Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance required
- Experience with SQL and Power BI required
- Experience preferably in managed care (preferred)
- Strong preference for experience in fraud investigations, payment integrity, or compliance (preferred)
- Prior experience in a health plan, government program, or investigatory agency SIU preferred
- Experience with SAS, Tableau, or other data visualization tools preferred
- Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
- Strong knowledge of CPT/HCPCS/ICD-10 coding, billing rules, and healthcare reimbursement models
- Familiarity with claim data structure
- Advanced Excel and Power Query skills
- Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms is highly desirable
- Exceptional analytical, problem-solving, and organizational skills
- Excellent interpersonal and communication skills
- Strong judgment and risk assessment capabilities
- Ability to interpret complex claims data and identify FWA red flags
- Proven ability to work independently and as part of a team
- Ability to manage multiple projects with competing deadlines
- Detail-oriented
- Strong commitment to integrity and ethical decision-making
