SIU Investigative Analyst

Job Title: SIU Investigative Analyst

Location: Geisinger Health Plan, Hughes

Department: Special Investigations Unit

Work Schedule: Days

Work Type: Full Time

Job Summary:

Work with the Special Investigations Unit to serve and protect members and Geisinger Health Plan from fraudulent, wasteful or abusive practices by helping to ensure timely review & initiation of fraud, waste and abuse cases.

Works under the direct supervision of the Director, Special Investigations.

Competencies and Skills:

Strong analytical abilities to review and evaluate information such as claims data, patterns and other supporting information related to case allegation details.

Ability to carry out detailed written or verbal instructions, as well as respond to requests effectively and efficiently.

Flexibility to work independently with self-initiative and limited direction, yet be collaborative and team-minded in a fast-paced and deadline sensitive team structure.

Curious, detail-oriented and inquisitive mindset required.

Excellent organizational and time management skills are needed. Strong problem-solving and decision- making skills to work through challenging and complex case details are required.

Very strong written and verbal communication skills are required. The ability to obtain information from others and deliver information in a concise and clear manner is critical.

Excellent computer skills are needed. The ability to navigate and understands claims data and various databases in order to develop and document case allegations is required.

A strong proficiency in Excel with the ability to effectively manipulate and organize complex data is preferred. A strong claims knowledge is beneficial.

Education and or Experience:

Bachelor’s Degree in Health Care Administration, Business, or related field required (MBA preferred); 3 years of related investigative or analyst experience in healthcare, data reporting and/or data analysis required.

AHFI, CPC/medical coding, Nursing background or CFE or formal data analyst background would be preferred.

Prior experience in compliance, regulation, SIU, or similar position related to data analysis or an insurance-related field is beneficial.

Proficiency in business intelligence software and reporting tools including, but are not limited to, MS SQL Server Components and Microsoft SQL, Oracle, Business Objects (Crystal Reports, Web Intelligence, OLAP, Universes, and Xcelsius), and Microsoft Office (Word, Excel, PowerPoint, Access and Project) are preferred.

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