[Remote] Healthcare Fraud Analyst (Operations Operational Analyst IV)

Note: The job is a remote job and is open to candidates in USA. Medica is a nonprofit health plan serving over a million members across multiple states. The Healthcare Fraud Analyst will operationalize business and regulatory requirements, focusing on project management and process improvement while collaborating with various teams to enhance efficiency and security in member data.
• Responsibilities
• Identify efficient ways to save money by using our Healthcare Fraud Shield tool – Pre-Shield
• Collaborate with teams across technology, security, compliance, and health services to identify opportunities to create efficiency and security in member data
• Assist with coordination of investigations and suspected fraudulent billing or inflated billing
• Skills
• Bachelor's degree or equivalent experience in related field
• 7 years of work experience beyond degree
• Prior experience managing a vendor relationship with a product like Pre-shield
• Demonstrated ability to compile reports, conduct analysis, and prepare leadership presentations
• Investigative skills, interest, and aptitude
• Strong attention to detail and organizational skills
• Strong written and verbal communication skills
• Working knowledge of healthcare claims and billing systems
• Benefits
• Competitive medical
• Dental
• Vision
• PTO
• Holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services
• Company Overview
• Medica is a company that provides health coverage to meet customers needs for health plan. It was founded in 1975, and is headquartered in Minnetonka, Minnesota, USA, with a workforce of 1001-5000 employees. Its website is https://www.medica.com.

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