Fraud, Waste and Abuse Investigator Job in Virginia Beach 23464, Virginia Us
Summary:
Responsible for gathering requirements, performing analysis, supporting the development and testing processes, and understanding and documenting the applications, data, and associated technologies for Fraud, Waste and Abuse.
Responsibilities:
1. Provide analytical support to department through execution of reports and analysis of results.
2. Update and execute routine programs to build databases and produce reporting deliverables for fraud, waste and abuse.
3. Document applications for use in training, maintenance, and department procedures
4. Modify system tables used by applications and reports according to system maintenance guidelines.
5. Able to perform moderate to complex queries. Moderate understanding of database tables, relations, data types, and values.
6. Evaluate and test moderately complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Document and track product defects. Coordinate problem resolution with business owners and IT.
7. Develop basic reporting applications and reports
8. Work under general supervision.
9. Other Duties as Assigned
Qualifications:
Education:
Required:
Bachelor's degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.
Years and Type of Experience Required::
Required:
Minimum of 3 years of related work experience in data analysis, report development and/or application development/implementation
Preferred:
Minimum of 3 years of related work experience in data analysis, report development and/or application development/implementation with a minimum of 1 year in healthcare or financial analysis.
Specific Technical Skills:
Required:
- Demonstrate basic knowledge of the inter-relationship among various managed care operational areas.
- Demonstrate an intermediate level of understanding of departments reporting solution applications, data definitions, and database structures.
- Experience with Microsoft Excel, Access and other Microsoft Office products.
Preferred:
- Experience in ETL (Extract, Transform, and Loading) of data.
- Knowledge of a structured query language, such as Microsoft Access, TSQL, PL/SQL, SPSS or SAS.
Other:
Required:
- Manage multiple priorities.
- Able to communicate effectively, written and verbally, with internal and external customers
- Ability to interface effectively with technical, clinical and business owners, at the Plan and Corporate Office levels.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems.
- Able to actively contribute in team based environment.
- Demonstrate motivation and innovation for self-improvement.
PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate other information appliances.
- Must be able to operate a telephone