Anthem, Inc. Bus Info Analyst Sr (Fraud Investigation) in Hialeah, Florida
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Responsible for analyzing, reporting and developing recommendations on data related to complex and varied business metrics. Typically provides technical assistance to lower level staff.
Primary duties may include, but are not limited to: Creates and maintains databases to track business performance.
Analyzes data and summarizes performance using summary statistical procedures.
Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
Creates and publishes periodic reports, as well as any necessary ad hoc reports.
May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
May make recommendations based upon data analysis.
Conducts data mining activities using available tools and performs comprehensive analysis and evaluation of the collected data in order to detect fraudulent, abusive or wasteful activities or patterns.
Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control.
Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
Requires a BS/BA degree in related field and/or current certification as a Certified Professional Coder (AAPC or AHIMA)
A minimum of 3 - 5 years data analysis or related experience; or any combination of education and experience which would provide an equivalent background.
Experience with relational databases and knowledge of query tools and statistical software is required.
Ability to manipulate large sets of data is strongly preferred.
Strong analytical, organizational and problem solving skills are strongly preferred.
This job is focused on complex and varied metrics, making recommendations and providing assistance to staff as compared to the Bus Info Analyst II job.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.