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.

Responsibilities

• Analyze large datasets to identify patterns, trends, and anomalies indicative of fraudulent activity utilizing advanced analytical techniques and tools to support development of investigative leads
• Collaborate with auditors and investigators to prepare reports and provider education letters
• Manage quarterly CMS fraud reports and regulatory memos to determine if Devoted has any FWA exposure/ or risk
• Intaking and triaging referrals related to fraud, waste, and abuse, inclusive of internal and external referrals
• Develop comprehensive reports summarizing analyses and trends with recommendations for targeted audits and investigations
• Work closely with internal departments (e.g.,Payment Integrity, Claims, Clinical Escalations) to share findings and coordinate on concept development and FWA scheme targeting criteria
• Develop educational materials for internal and external stakeholders (e.g., providers, members, employees)
• Conduct quality assurance (QA) review of case documentation
• Attend 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 efforts

Skills

• Bachelor's degree in business, healthcare administration, criminal justice, or a related field
• Minimum of 3 years of experience in healthcare fraud investigation, medical claims analysis, or a related field
• Proficiency in data analysis tools (e.g., Excel/Google Sheets) and knowledge of statistical analysis techniques
• Strong analytical and problem-solving skills, with the ability to interpret complex data and draw actionable insights
• Excellent verbal and written communication skills, with the ability to present findings clearly to diverse audiences
• High level of attention to detail and accuracy in data analysis and reporting
• Minimum of 3 plus years in fraud analytics and detection within healthcare, insurance, Medicare Advantage Organization/Managed Care setting, or law enforcement
• Experience in a health plan SIU is highly desirable
• Experience 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 data
• Familiarity with Medicare and Medicaid regulations, as well as industry standards related to fraud detection and prevention
• Familiarity with healthcare claims processing and coding is a plus
• Ability to present findings and collaborate with cross-functional teams, including Payment Integrity and Compliance

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....
• *\*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.*

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