Intelligence Analyst
IEHP
SQLTableau
SIU 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
- The Special Investigations Unit (SIU) Intelligence Analyst is responsible for providing proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs.
- This role bridges data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads and escalate high-impact patterns for formal investigation.
- Conduct data mining, statistical trend analysis, and anomaly detection to validate leads.
- Escalate high-impact patterns for formal investigation.
- Collaborate with investigations and cross-functional teams to support SIU operations.
- Incorporate IEHP’s Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation into work.
- Manage multiple projects and competing deadlines in a high-stakes environment.
- Work independently and as part of a team to detect FWA and support compliance efforts.
- Interpret complex claims data and identify red flags.
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.
- Strong preference for experience in fraud investigations, payment integrity, or compliance.
- 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.
