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Insight Analyst

Location: Lombard, IL, United States
Job # 11309228
Date Posted: 08-29-2018
Insight Analyst- Irvine, Lombard, IL 60148 Or Minneapolis, MN 55416
Pay Rate: $17/hr.
Schedule: 40 hours a week
9 month Assignment with the possibility of extension

Start Date: ASAP  

Job Description
The Insight Analyst will be responsible for reviewing healthcare claims for possible fraud, waste and abuse. Actively work to identify and prevent payment of inappropriate or erroneous charges submitted by healthcare providers. Required to manage workload to ensure that cases are handled appropriately and resolved in a timely manner.
Job Responsibilities
  • Properly manage daily workload to ensure that established task turn-around-times (TATs) are met 
  • Write Insight Summary Reports detailing case findings and recommendations
  • Thoroughly review medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up
  • Use the appropriate resources (state or board websites) to verify provider licensure and check for sanctions
  • Work closely with the Insight Analyst Assistants to manage workload and provide direction
  • Attend anti-fraud or healthcare related seminars, audio conferences and webinars throughout the year for the purposes of continuing education and training
  • Acquire/maintain proficiency on all aspects of healthcare Fraud, Waste and Abuse
  • Conduct research on providers using the internet and other resources for case development
  • Understand and adhere to HIPAA privacy requirements

Job Requirements
  • BA/BS degree in law enforcement, criminal justice, criminology or related field required. 2+ years of fraud, waste and abuse experience may be substituted for each year of academic study
  • Healthcare claims industry experience highly preferred
  • Experience with government healthcare programs preferred (Medicare, Medicaid)
  • Must be proficient in Microsoft Office applications
  • Must be detail oriented and possess the ability to multi-task
Healthcare fraud designation required. CFE or AHFI certifications preferred

Please send your resume in a PDF or Word format for immediate consideration.
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