SIU Intelligence Analyst
3 weeks ago
What you can expect Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience The Special Investigations Unit (SIU) Intelligence Analyst is responsible for providing proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs. This role bridges data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads and elevate high-impact patterns for formal investigation. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Hybrid schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Education & Requirements Required: Bachelor’s degree in Criminal Justice, Data Science, Healthcare Administration, Statistics, Business Administration, Public Health, or a related field from an accredited institution required. Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred. Advanced SAS Programmer certification preferred. Required: Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance required. Experience with SQL and Power BI required. Preferred: Experience preferably in managed care. Strong preference for experience in fraud investigations, payment integrity, or compliance. Prior experience in a health plan, government program, or investigatory agency SIU preferred. Experience with SAS, Tableau, or other data visualization tools preferred. Key Qualifications Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred. Strong knowledge of CPT/HCPCS/ICD-10 coding, billing rules, and healthcare reimbursement models. Familiarity with claim data structure. Advanced Excel and Power Query skills. Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms is highly desirable. Exceptional analytical, problem-solving, and organizational skills. Excellent interpersonal and communication skills, capable of working effectively across various departments and with external partners. Strong judgment and risk assessment capabilities. Ability to interpret complex claims data and identify FWA red flags. Proven ability to work independently and as part of a team in a high-stakes environment. Ability to manage multiple projects with competing deadlines. Detail-oriented. Strong commitment to integrity and ethical decision-making. Start your journey towards a thriving future with IEHP and apply TODAY #J-18808-Ljbffr
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SIU Intelligence Analyst
7 days ago
Rancho Cucamonga, United States Inland Empire Health Plan Full timeOverviewWhat you can expect!Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!The Special Investigations Unit (SIU) Intelligence Analyst is responsible for providing proactive, data-driven intelligence to prevent and detect healthcare...
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Healthcare FWA Intelligence Analyst — Hybrid
3 weeks ago
Rancho Cucamonga, United States Inland Empire Health Plans Full timeA healthcare organization in California seeks an SIU Intelligence Analyst who will work on data-driven intelligence efforts to combat healthcare fraud. Responsibilities include data mining, trend analysis, and engaging with various departments. Ideal candidates will have a Bachelor's degree and three years of experience in healthcare data analytics and must...
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ERP/BI Analyst
3 weeks ago
Rancho Cucamonga, United States ExecutivePlacements.com Full timeSummary Under general supervision, the ERP/BI Analyst works independently, exercising initiative and judgment in performing a broad range of ERP and business intelligence responsibilities. This role combines functional ERP understanding with data analysis and reporting capabilities to help business teams optimize processes, make data-driven decisions, and...
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Sr. Financial Analyst
4 weeks ago
Rancho Cucamonga, United States Bradshaw Home Full timeSr. Financial AnalystThe Sr. Financial Analyst is a key partner for the Commercial Organization and other cross-functional groups providing reporting, analytical insights, and overall process improvement. This position is hybrid, three days on-site at our corporate office in Rancho Cucamonga, California.Key responsibilities include building reports, tracking...
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Sr. Financial Analyst
2 weeks ago
Rancho Cucamonga, United States Bradshaw Home Full timeThe Sr. Financial Analyst is a key partner for the Commercial Organization and other cross-functional groups providing reporting, analytical insights, and overall process improvement. This position is hybrid, 3 days on-site at our corporate office in Rancho Cucamonga, California. Key responsibilities include building reports, tracking and measuring results,...
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Sr. Financial Analyst
3 weeks ago
Rancho Cucamonga, United States Bradshaw Home Full timeOverviewThe Sr. Financial Analyst - Commercial at Bradshaw Home partners with the Commercial Organization and cross-functional groups to provide reporting, analytical insights, and process improvement. This position is hybrid, with 3 days on-site at the corporate office in Rancho Cucamonga, California.ResponsibilitiesDevelop the analysis and reporting...
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Sr. Financial Analyst
2 days ago
Rancho Cucamonga, CA, United States Bradshaw Home Full timeThe Sr. Financial Analyst is a key partner for the Commercial Organization and other cross-functional groups providing reporting, analytical insights, and overall process improvement. This position is hybrid, 3 days on-site at our corporate office in Rancho Cucamonga, California. Key responsibilities include building reports, tracking and measuring results,...
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Sr. Financial Analyst
2 weeks ago
Rancho Cucamonga, CA, United States Bradshaw Home Full timeThe Sr. Financial Analyst is a key partner for the Commercial Organization and other cross-functional groups providing reporting, analytical insights, and overall process improvement. This position is hybrid, 3 days on-site at our corporate office in Rancho Cucamonga, California. Key responsibilities include building reports, tracking and measuring results,...
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Special Investigations Unit
7 days ago
Rancho Cucamonga, United States Inland Empire Health Plan Full timeOverviewWhat you can expect!Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory...
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Rio Rancho, United States New Mexico Staffing Full timeJob SummaryUnder direct supervision of the Manager, SIU, the Team Lead is responsible to lead a small team of investigators and provide oversight on daily investigative activities as a back-up to the SIU Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight and guidance throughout the...
