Fraud & Healthcare Analytics Specialist
Habitat For Humanity Of Durham
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Job summary
Blue Cross NC is seeking a strategic analytics partner to support the Special Investigations Unit and Payment Integrity teams with actionable intelligence, dashboards, and audit support. The role combines healthcare claims expertise with advanced analysis and stakeholder engagement to drive savings and operational improvements.
The analyst translates complex healthcare data into meaningful insights, supports provider investigations and overpayment recovery, and communicates findings to
Qualifications
- Strong analytical, problem-solving and communication skills.
- 3+ years in healthcare analytics, SIU, or Payment Integrity (or 5+ years without degree).
- Experience with data visualization and dashboard development is preferred.
Responsibilities
- Partner with SIU, Payment Integrity, Clinical, Finance, and operations to identify needs and develop analytical solutions for fraud, waste, abuse, and performance management.
- Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics for outcomes, risk, savings, recoveries, and KPIs.
- Analyze healthcare claims, provider, member, audit, and investigation data to identify trends and opportunities for improvement.
- Develop recurring and ad hoc financial and operational reporting to measure effectiveness and ROI.
- Design and document statistically valid sampling methodologies to support audits and extrapolation activities.
- Collaborate with BI Analysts, Data Scientists, and others to define data requirements and improve data quality.
Skills
Education
Tools
Job description
Blue Cross NC is seeking a strategic analytics partner to support the Special Investigations Unit and Payment Integrity teams with actionable intelligence, dashboards, and audit support. The role combines healthcare claims expertise with advanced analysis and stakeholder engagement to drive savings and operational improvements.
The analyst translates complex healthcare data into meaningful insights, supports provider investigations and overpayment recovery, and communicates findings to
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