HEALTH INSURANCE FRAUD ANALYST I - 72004151

Health Insurance Fraud Analyst I

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. 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, and 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 : Strong problem-solving abilities, ability to multi-task and complete multiple project assignments simultaneously, demonstrates exemplary organizational and prioritization skills, demonstrates exceptional ability to work as a team member, demonstrates a well-developed willingness to learn, excellent written and verbal communication skills, ability to maintain confidentiality, proficiency in Microsoft Office Suite, etc., ability to effectively and efficiently work both independently and as a contributing member of a team, ability to plan, organize, and prioritize work assignments to meet deadlines, integrity, communication, respect, excellence, accountability, teamwork, empowerment.

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.

This position is located in Tallahassee, FL.