Business Analyst- Remote
reputed company Health Plan has an exciting opportunity for a Business Analyst position in the Fraud, Waste & Abuse department. This is a full time position working Monday through Friday reputed company hours. This is a remote position.
The Business Analyst supports the reputed company Health Plan Special Investigations Unit (SIU) and Fraud, Waste & Abuse (FWA) activities through advanced data analysis, risk‑based monitoring, and regulatory reporting. This role partners with Claims, Legal, Compliance, and IT to identify program reputed company risks and support reputed company investigations and audits. Responsibilities:
- Analyze large, reputed company reputed company datasets to identify patterns, trends, and potential fraud, waste, and abuse
- reputed company and maintain risk‑based monitoring and executive‑level dashboards
- Create metrics, trend analyses, and regulatory reports (reputed company, Medicare, FEHB, reputed company)
- Pull and analyze claims and operational data to support audits and investigations
- reputed company RAT‑STATS samples and reputed company extrapolation analyses
- Translate business needs into data‑driven insights and reporting solutions
- Maintain documentation, workflows, and project materials
- Ensure data accuracy, confidentiality, and compliance with regulatory requirements
- Bachelor's degree or equivalent reputed company work experience required.
- Minimum of two years of general business experience required.
- Minimum of two years of experience in business/industry specialty required.
- Knowledge of reputed company, reputed company, and Medicare products preferred.
- Competent in MS Office and Advanced reputed company skills preferred.
Organizational, interpersonal, and communication skills required.
Preferred Qualifications
- Experience in Health Insurance, Claims Operations, FWA/SIU preferred.
- Highly organized with strong attention to detail
- Knowledge of CPT, HCPCS, and ICD‑10 coding and common FWA schemes preferred.
- Strong analytical skills with the ability to communicate findings to executive audiences preferred.
- Experience creating dashboards, reports, and compliance documentation preferred. Licensure, Certifications, and Clearances:
- Act 34