Primary Responsibilities include:-Write queries and alter scripts using SQL to pull data for further analysis in excel.-Complete data analysis requests and written reports with details of the analysis for other departments of interest.-Use excel to analyze and manipulate data for reports requested from clients.-Work with local management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests.-Validate data analysis results and analytically identify potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations.-Utilize data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seeks out and develops leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources.-Support management requests for CMS reporting requirements. Use leadership and project management skills to report findings in a timely and efficient time frame.-Adhere to strict Quality Check policy and procedures for personal and team projects.-Work with Statisticians and Data Analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, overpayments, and/or administrative actions.-Prepare, develop and participate in presenting data and findings as it relates to fraud, waste and/or abuse data analysis.-Maintain chain of custody on all documents and follow all confidentiality and security guidelines.-Analyze and report DAR (Dollars at Risk) for projects of interest.

Primary responsibilities include:-Identify & understand data trends and patterns that can be translated into analytics- Conduct independent research through both internal and external databases- Perform data analysis of claims history to substantiate fraud and abuseallegations- Build queries and alter scripts for claims analysis using SQL and Python -Build analytics for reoccurring and ad-hoc monthly reports -Interact/coordinates activities with all levels of leadership and clients about course of investigation or analytical development-Lead projects to completion by contributing to database creation, statistical modeling and financial reports-Prepare accurate reports to detect and identify fraud trends, analysis of those trends and risk mitigation recommendation-Completed training on beginner level SQL and canned coding experience

• Primary responsibilities included:• Triage, investigate and resolve instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community.• Conduct confidential post-pay investigations, document relevant findings, and report any illegal activities in accordance with all laws and regulations.• Conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation.• Analyze, scrub and sample data in order to detect any fraudulent billing patterns.• Act as a subject matter with identifying, communicating and recovering losses as deemed appropriate.• When required, provide testimonials regarding the investigation.

• Conduct independent investigations resulting from the discovery of situations that potentially involve fraud or abuse.• Utilize data analysis techniques to detect aberrancies in Medicare claims data, and proactively seeks out and develops leads received from a variety of sources (e.g., CMS, OIG, fraud alerts).• Complete written referrals to law enforcement and takes steps to recoup overpaid monies.• Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiates appropriate action. Makes potential fraud determinations by utilizing a variety of sources such as the ZPIC’s internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act.• Develop and prepare potential Fraud Alerts and Program Vulnerabilities for submission to CMS; shares information on current fraud investigations with other Medicare contractors, law enforcement, and other applicable stakeholders.• Review and respond to requests for information from Medicare stakeholders as assigned; pursue applicable administrative actions during investigation/case development (e.g. payment suspensions, civil monetary penalties, requests for exclusion, etc.)• Participate in onsite audits in conjunction with investigation development.• Maintain chain of custody on all documents and follows all confidentiality and security guidelines.• Compile and maintain various documentation and other reporting requirements.

Primary responsibilities include sales for the products offered as well as counseling, investigating and consulting identity theft victims and their cases.