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.
Working Conditions/Physical Demands:
Work is typically performed in an office environment.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.