HEALTH INSURANCE FRAUD ANALYST I

Requisition No : 864042

Agency : Management Services

Working Title : HEALTH INSURANCE FRAUD ANALYST I - 72004151

Pay Plan : Career Service

Position Number : 72004151

Salary : $48,000 - $52,000

Posting Closing Date : 11 / 05 / 2025

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Health Insurance Fraud Analyst I

Division of State Group Insurance

State of Florida Department of Management Services

This position is located in Tallahassee, FL

Internal Agency Only

Position Overview and Responsibilities :

The selected candidate will join the Division of State Group Insurance; Program Integrity Unit as a Health Insurance Fraud Analyst I and will assist with performing activities related to data analytics to identify fraud, waste, or abuse in claims data. The Program Integrity Unit was established to detect and prevent fraud, waste and abuse related to the State Employees' Group Health Insurance Program. The position will be responsible for providing support to the following positions : Health Insurance Fraud Analyst III, Health Insurance Fraud Analyst II, Audit Manager, and the Program Integrity Unit Manager during their day-to-day activities. This position requires a high degree of confidentiality, accuracy, and adherence to deadlines.

Specific responsibilities for this position will include, but not be limited to, the following :

• Applies knowledge of heath care coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies and relevant laws to find suspicious patterns in claims data and other sources.
• Applies independent judgment to assist in creating investigative work plans and developing case strategies based upon analysis.
• Assists in organizing data and preparing a written summary of investigative steps, conclusions, recommendations with attention to detail and a high level of accuracy.
• Assists in preparing clear and concise investigatory reports to support findings of potential fraud, waste and abuse.
• Assists in preparing statistical / financial analysis reports and graphic presentation for notification of findings.
• Maintains security and confidentiality of all protected health information encountered in performance of duties.
• Works cooperatively and constructively with team members
• Provides support to the DSGI Director, Deputy Director and other operational staff as needed.

Other Duties :

Performs additional duties and projects assigned by management and provides cross-functional support to other DSGI work units for special projects and peak workload periods as required to support the Division's operational needs. Provides prompt, professional and courteous customer service in response to all inquiries and requests for information received by DSGI.

Knowledge, Skills, and Abilities :

Minimum Qualifications :

Two years of professional work experience related to the duties and responsibilities outlined above. Postsecondary education in the field(s) of criminology, healthcare administration, accounting, risk management, or similar discipline may be used as an alternative for years of experience on a year-for-year basis.

Our Organization and Mission :

Under the direction of Governor Ron DeSantis, Secretary Pedro Allende and DMS' Executive Leadership Team, the Florida Department of Management Services (DMS) is a customer-oriented agency with a broad portfolio that includes the efficient use and management of real estate, procurement, human resources, group insurance, retirement, telecommunications, fleet, and federal property assistance programs used throughout Florida's state government. It is against this backdrop that DMS strives to demonstrate its motto, "We serve those who serve Florida."

Special Notes :

DMS is committed to successfully recruiting and onboarding talented and skilled individuals into its workforce. We recognize the extensive training, experience, and transferrable skills that veterans and individuals with disabilities bring to the workforce. Veterans and individuals with disabilities are encouraged to contact our recruiter for guidance and answers to questions through the following provided email addresses :

DMS.Ability@dms.fl.gov

DMS.Veterans@dms.fl.gov

An individual with a disability is qualified if he or she satisfies the skills, experience, and other job related requirements for a position and can perform the essential functions of the position with or without reasonable accommodation. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must contact the DMS Human Resources (HR) Office at (850) 488-2707. DMS requests applicants notify HR in advance to allow sufficient time to provide the accommodation.

Successful completion of background screening will be required for this position.

The State of Florida is an Equal Opportunity Employer / Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and / or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS' PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans' Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.

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