Job Description

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about

who we are at Point32Health

.

Job Summary

Are you interested in becoming part of a dynamic team that is looking to innovate and improve?


Do you want to be part of a company that is committed to giving back to the community?


Point32Health is currently seeking highly motivated individuals to join our organization as an Analytics & Triage Fraud Analyst within our Special Investigations Unit (“SIU”). The Analytics & Triage Fraud Analyst is an essential team member of the SIU, responsible for analyzing claim trends, patterns and outliers, developing and refining queries to detect potentially fraudulent claim submissions and performing initial background on newly identified leads.

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing (top five):

• General
• Demonstrate strong business problem comprehension, by developing analytic use cases (Who? What? Why?) that accurately capture business needs
• Use programming and analytical skills to address analytic use cases, applying statistics where appropriate
• Appropriately apply visualization best practices and data storytelling techniques
• Apply a high level of QA rigor, proactively leveraging external validation sources and peer review
• Develop documentation and methodologies for analyses and deliverables
• Deliver a clear and concise presentation of findings to business owners and peers, tailoring the presentation to the audience
• Monitor business adoption and utilization of analytic output, and solicit business feedback
• Demonstrate problem solving aptitude through critique of analytic methodologies and studies completed by peers and third parties
• Exemplify the characteristics of a lifelong learner, consistently seeking additional training and build knowledge/experience of business acumen, tools, languages and data sources
• Act as a Lean Thinker, applying continuous improvement philosophies and approaches to identify and address inefficiencies in your day-to-day work
• Meets assigned timelines and escalates risks/barriers as needed
• Perform other duties as assigned
• Role-Specific
• Perform analytical troubleshooting, capability building and ad hoc requests of monthly provider claims files, including communication with external stakeholders
• Support the activities of a cross-functional team charged with the following objectives:
• Produce standard reporting and analytics for risk-based providers
• Generate hypotheses for provider medical cost trends and quality performance
• Initiate analyses designed to test trends, understand performance variability (at a group and physician level), and suggest opportunities for performance improvement
• Act as a liaison between corporate stakeholders and the IT department to ensure transparency and timely communication of questions or issues
• Perform ad hoc analyses as required based on provider inquiries and internal business needs
• Other duties and projects as assigned.

QUALIFICATIONS – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Bachelor’s degree in an analytics-related field

EXPERIENCE (minimum years required):

• 3-5 years of experience, preferably in a payer/provider setting

SKILL REQUIREMENTS:

• Moderate to complex analytics experience required
• Applied statistical experience required
• Visualization best practices and data storytelling methods required
• Intermediate programming skills (e.g. SAS, SQL, R, Python) required
• Tableau or similar data visualization tool development experience preferred
• Experience with health insurance claims data preferred
• Demonstrated ability to manage tasks independently, take ownership of responsibilities and meet deadlines
• Strong written and oral communication skills

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$74,864.33 -$112,296.49

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact

TA_operations@point32health.org

Job Tags

Full time, Work at office,

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