Fraud Analytics Consultant
CVS Pharmacy - New York City, NY
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Job DescriptionIt's a new day in healthcareCombining CVS Health and Aetna was a ground-breaking moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total terested in generating analytical insights that help identify aberrant billing patterns resulting in improper payments to providers? In the past 4 years our membership has doubled and our market share has grown 50%; you will help us take all this to the next level, using your industry knowledge, passion for problem solving and quantitative analysis, and skills in communication and client management to identify, incubate, and deploy the next set of innovations to power the growth of tomorrow's business Generates potential fraud, waste, and abuse leads utilizing post-payment claims data and analytical analysis to identify aberrant billing patterns and emerging schemes. Consults with internal business partners to identify and understand their business problems and goals. Researches, manipulates, and prepares complex data through statistical analysis to act in a consultative capacity to internal/external customers. Demonstrates familiarity with areas of mathematical analysis methods, statistical analysis, and in-depth specialization analysis on varied healthcare data. Analyzes complex data for trends to evaluate programs and product solutions. Extracts data from multiple sources, creates integrated analytic datasets, reports, and studies to address business and research questions to make recommendations. Conducts contractual, legislative, policy, and other informational research and prepares concise documentation of methods, specifications, and findings. Creates and evaluates the data needs of assigned projects and assures the integrity of the data. Participates in presentations and consultations to constituents on methods, specifications, and findings. Manages personal resources efficiently to complete assigned projects accurately and on time. Participates in the development of project plans and timelines. Responsible for commitments to quality and on-time deliverables.Required Qualifications CPC Minimum 3 years of relevant data analytic experience. Strong knowledge of advanced analytic methods, statistical analyses, tools, and languages to analyze large data sets from multiple data sources. Demonstrated written and verbal communication skills with the ability to present information to various audiences.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Healthcare industry, policy, health care claims, products, and systems preferred. 2 years of healthcare or pharmaceutical industry experience is preferred. RN Licensure, AHFI Experience in SQL, programming using R or PythonEducation Bachelor's degree in Mathematics, Economics, Statistics, Healthcare or related discipline; or an equivalent combination of formal education and experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07