IEHP
Overview
1 day ago Be among the first 25 applicants 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 escalate high-impact patterns for formal investigation. Commitment to Quality: The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Responsibilities
Provide proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs. Bridge data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads. Escalate high-impact patterns for formal investigation. Collaborate with SIU and other departments to improve fraud detection and prevention initiatives.
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. Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred. Advanced SAS Programmer certification preferred.
Experience & Qualifications
Required: Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance. Experience with SQL and Power BI required. Preferred: Experience in managed care; strong preference for 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 Competencies
Knowledge of managed care industry operations, practices, and compliance program elements. 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 HCFS or similar case management platforms is highly desirable. Analytical, problem-solving, and organizational skills; excellent interpersonal and communication abilities. Strong judgment, risk assessment capabilities, and the ability to work independently and as part of a team in high-stakes environments. Ability to manage multiple projects with competing deadlines and a detail-oriented approach.
Compensation & Benefits
Pay Range: $71,572.80 USD Annually - $93,038.40 USD Annually Hybrid schedule Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs supporting 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
Job Function & Location
Job function: Other, Information Technology, and Management Industries: Hospitals and Health Care Location: Rancho Cucamonga, CA (as listed in posting)
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1 day ago Be among the first 25 applicants 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 escalate high-impact patterns for formal investigation. Commitment to Quality: The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Responsibilities
Provide proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs. Bridge data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads. Escalate high-impact patterns for formal investigation. Collaborate with SIU and other departments to improve fraud detection and prevention initiatives.
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. Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred. Advanced SAS Programmer certification preferred.
Experience & Qualifications
Required: Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance. Experience with SQL and Power BI required. Preferred: Experience in managed care; strong preference for 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 Competencies
Knowledge of managed care industry operations, practices, and compliance program elements. 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 HCFS or similar case management platforms is highly desirable. Analytical, problem-solving, and organizational skills; excellent interpersonal and communication abilities. Strong judgment, risk assessment capabilities, and the ability to work independently and as part of a team in high-stakes environments. Ability to manage multiple projects with competing deadlines and a detail-oriented approach.
Compensation & Benefits
Pay Range: $71,572.80 USD Annually - $93,038.40 USD Annually Hybrid schedule Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs supporting 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
Job Function & Location
Job function: Other, Information Technology, and Management Industries: Hospitals and Health Care Location: Rancho Cucamonga, CA (as listed in posting)
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr