Special Investigations Data Analyst

Resp & Qualifications

COMPANY SUMMARY:

CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region's largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.

In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company's COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company's core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.

At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.

We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees' experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.

• Women make up around 70% of CareFirst's employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
• We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
• Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.

As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company's employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company's continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal's 2019 list of top corporate givers, respectively.

PURPOSE:
The Special Investigations Data Analyst will be responsible for investigations, analysis, and preparation of reports and investigations.

ESSENTIAL FUNCTIONS:

• Responsible for importing, cleaning, transforming, validating or modeling data with the purpose of making conclusions from the data for decision-making purposes. Ensure data quality and data integrity for all reports generated by the data team.

• Responsible for supporting the prevention, detection, investigation, reporting and when appropriate, recovery of money related to health care fraud, waste, and abuse across the organization, which includes generating accurate and timely analysis and reports to support the SIU initiatives to identify fraud, waste and abuse.

• Present findings individually or with a group of his/her peers that cooperatively works to give SIU management and associates a synopsis of their findings.

• Work closely with the SIU Forensic Analyst in preparing SIU outlier reports and analysis for use by the department when determining whether to pursue an investigation and/or to provide additional information during an investigation.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Information Systems or related quantitative field (finance, computer science, mathematics etc...).

Experience: 2 years business experience in a health care environment working knowledge of the managed health care business, including data analysis and medical coding.

Knowledge, Skills and Abilities (KSAs)

• Possess strong math and analytical skills.
• Excellent PC skills including a working knowledge of Microsoft ACCESS and EXCEL and relational databases/SQL Server.
• Background in extracting and compiling data, creating reports, and displaying information, along with experience combining clinical and financial data.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department: Special Investigations Unit - MD

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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