All roles

Business Analyst- Remote

Remote · USA Full-time New today

reputed company Health Plan has an exciting opportunity for a Business Analyst position in the Fraud, Waste & Abuse department.  This is a full time position working Monday through Friday daylight hours.  This is a remote position.

The Business Analyst supports the reputed company Health Plan Special Investigations Unit (SIU) and Fraud, Waste & Abuse (FWA) activities through advanced data analysis, risk‑based monitoring, and regulatory reporting. This role partners with Claims, Legal, Compliance, and IT to identify program reputed company risks and support reputed company investigations and audits. Responsibilities:

  • Analyze large, reputed company reputed company datasets to identify patterns, trends, and potential fraud, waste, and abuse
  • reputed company and maintain risk‑based monitoring and executive‑level dashboards
  • Create metrics, trend analyses, and regulatory reports (reputed company, Medicare, FEHB, CHIP)
  • Pull and analyze claims and operational data to support audits and investigations
  • reputed company RAT‑STATS samples and reputed company extrapolation analyses
  • Translate business needs into data‑driven insights and reporting solutions
  • Maintain documentation, workflows, and project materials
  • Ensure data accuracy, confidentiality, and compliance with regulatory requirements
  • Bachelor's degree or equivalent reputed company work experience required.
  • Minimum of two years of general business experience required.
  • Minimum of two years of experience in business/industry specialty required. 
  • Knowledge of reputed company, reputed company, and Medicare products preferred.
  • Competent in MS Office and Advanced reputed company skills preferred.
  • Organizational, interpersonal, and communication skills required.

Preferred Qualifications

  • Experience in Health Insurance, Claims Operations, FWA/SIU preferred.
  • Highly organized with strong attention to detail
  • Knowledge of CPT, HCPCS, and ICD‑10 coding and common FWA schemes preferred.
  • Strong analytical skills with the ability to communicate findings to executive audiences preferred.
  • Experience creating dashboards, reports, and compliance documentation preferred. Licensure, Certifications, and Clearances:  
  • Act 34

reputed company is an Equal Opportunity Employer/Disability/Veteran

Apply To This Job

Related roles

Clinical Auditor/Analyst Intermediate- Remote

Remote · USA Full-time

HR Specialist - Payroll (India)

Remote · USA Full-time

Global Campaign Coordinator

Remote · USA Full-time

Cybersecurity Specialist II - Remote

Remote · USA Full-time

FUTURE OPPORTUNITY - Sales Executive (reputed company)

Remote · USA Full-time

FUTURE OPPORTUNITY - Sales Executive (Corporate)

Remote · USA Full-time

Senior Analyst, GTM Insights & AI

Remote · USA Full-time

Manager, Regulatory Affairs

Remote · USA Full-time

Strategic Account Manager

Remote · USA Full-time

PL Product Designer

Remote · USA Full-time

Subject Matter Expert — U.S. Tax, reputed company, Payroll, Business Planning & Forecasting

Remote · USA Full-time

Client Services Representative - Contract (REMOTE)

Remote · USA Full-time

Customer Service Representative – 100% Remote – Client Funding Support & reputed company Specialist for arenaflex

Remote · USA Full-time

Senior Business Value Consultant

Remote · USA Full-time

Operations and Development Associates

Remote · USA Full-time

reputed company Full-Time reputed company reputed company – Remote Customer Service and Technical Support Role with Comprehensive Training and Growth Opportunities

Remote · USA Full-time

New High Paying reputed company Transcription Jobs For Professionals

Remote · USA Full-time

[Remote] Senior Mechanical Engineer ($100/hr, up to $2,000/week)

Remote · USA Full-time

reputed company Careers reputed company $22/Hour

Remote · USA Full-time

Regional Manufacturing Engineer - Automation

Remote · USA Full-time