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Investigative Data Analyst

Anthem

Location: Tampa, Florida
Type: Full-Time, Non-Remote
Posted on: May 10, 2021
This job is no longer available from the source.
Description
SHIFT: Day Job
SCHEDULE: Full-time
Investigative Data Analyst
This position may be located at any location or open to remote. The preferred locations are Atlanta, GA and Virginia Beach, VA.
Responsible for working with investigators, clinicians in HQA and the MBUs to data mining tools to determine if patterns of abusive practices or fraudulent activities are occurring within the company.
Primary duties may include, but are not limited to:
• Develop possible scenarios and impacts from trends and patterns noted and perform further research.
• Determine the potential financial impact of adverse trends and work with clinicians to determine possible quality of care issues that need to be investigated.
• Include scenarios to detect member and provider fraud schemes.
Qualifications
• Requires a BA/BS degree, 1-3 years related experience in statistics, actuarial analysis or medical profiling; or any combination of education and experience, which would provide an equivalent background.
• Current RN or law enforcement experience preferred.
• Knowledge of claims and benefits management in a managed care organization, familiarity with health care industry and issues, contracts, cost containment practices, and case management techniques preferred.
• Ability to travel on a regional and statewide basis.
• SQL developer experience required and knowledge of query tools.
• Expert level in Microsoft Excel and Access.
• The ability to use SQL developer tools (2012 or higher); e.g., Visual Studio Code, Server Data Tools, Server Mgmt. Studio, Server BI.
• SAS developer, Teradata analytics, Microsoft DOT NET and/or JavaScript experience highly desirable.
• Experience with relational databases and EdWard are a plus.
• Project Management experience preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.