[Remote] Senior Compliance Analyst, Special Investigations Unit

Note: The job is a remote job and is open to candidates in USA. Devoted Health is on a mission to dramatically improve the health and well-being of older Americans. The Senior Compliance Analyst in the Special Investigations Unit (SIU) plays a crucial role in detecting potentially fraudulent activities within the health plan by analyzing data, conducting research, and preparing reports to mitigate fraud risk and ensure compliance with regulatory requirements.ResponsibilitiesAnalyze large datasets to identify patterns, trends, and anomalies indicative of fraudulent activity utilizing advanced analytical techniques and tools to support development of investigative leadsCollaborate with auditors and investigators to prepare reports and provider education lettersManage quarterly CMS fraud reports and regulatory memos to determine if Devoted has any FWA exposure/ or riskIntaking and triaging referrals related to fraud, waste, and abuse, inclusive of internal and external referralsDevelop comprehensive reports summarizing analyses and trends with recommendations for targeted audits and investigationsWork closely with internal departments (e.g.,Payment Integrity, Claims, Clinical Escalations) to share findings and coordinate on concept development and FWA scheme targeting criteriaDevelop educational materials for internal and external stakeholders (e.g., providers, members, employees)Conduct quality assurance (QA) review of case documentationAttend and participate in SIU and PI status meetings (weekly, bi-weekly, quarterly, ad-hoc)Stay updated on relevant laws, regulations, and industry standards related to healthcare fraud and contribute to compliance effortsSkillsBachelor's degree in business, healthcare administration, criminal justice, or a related fieldMinimum of 3 years of experience in healthcare fraud investigation, medical claims analysis, or a related fieldProficiency in data analysis tools (e.g., Excel/Google Sheets) and knowledge of statistical analysis techniquesStrong analytical and problem-solving skills, with the ability to interpret complex data and draw actionable insightsExcellent verbal and written communication skills, with the ability to present findings clearly to diverse audiencesHigh level of attention to detail and accuracy in data analysis and reportingMinimum of 3 plus years in fraud analytics and detection within healthcare, insurance, Medicare Advantage Organization/Managed Care setting, or law enforcementExperience in a health plan SIU is highly desirableExperience in analyzing healthcare claims data, utilizing statistical tools and software for insights. (Data Platforms such as Looker, Tableau, Power BI, SQL, or Qlik Sense)Utilized Generative AI tools to automate routine investigative tasks, reducing manual review times for complex claim histories and surfacing hidden fraud indicators across high-volume dataFamiliarity with Medicare and Medicaid regulations, as well as industry standards related to fraud detection and preventionFamiliarity with healthcare claims processing and coding is a plusAbility to present findings and collaborate with cross-functional teams, including Payment Integrity and ComplianceBenefitsEmployer sponsored health, dental and vision plan with low or no premiumGenerous paid time off$100 monthly mobile or internet stipendStock options for all employeesBonus eligibility for all roles excluding Director and above; Commission eligibility for Sales rolesParental leave program401K programAnd more....*\*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.*Company OverviewDevoted Health is a healthcare company serving seniors and giving them a health care plan with personal guides and world-class technology. It was founded in 2017, and is headquartered in Waltham, Massachusetts, USA, with a workforce of 1001-5000 employees. Its website is https://devoted.com.