Senior Auditor - Medicaid Fraud & Data Analytics (Remote)

DelDOT; New Castle (PA); Hybride; USD 70 000 - 110 000; Plein temps

Avantages offerts par ce poste

Healthcare plan

Pension plan

Vacation leave

Paid parental leave

Résumé du poste

The Delaware Department of Justice is seeking an exceptional Senior Auditor to join the Medicaid Fraud Control Unit in the Fraud & Consumer Protection Division in the New Castle County office. The role focuses on providing auditing and data analysis expertise in health care fraud investigations and False Claims Act work.

You will work within a collaborative team, independently when needed, handling data mining, claims analysis, restitution calculations, and presenting findings.

Qualifications

• Bachelor’s degree or higher in Economics, Finance, Business, Computer Information Systems or related field.
• Three years of experience in designing analytical studies and data collection methods.
• Three years of experience interpreting laws, rules, regulations, standards, policies, and procedures.
• Strong planning, prioritizing, organizing, and problem solving skills.
• Ability to analyze data and make sound recommendations.
• Proficiency with data analysis software (Excel, Access, SAP BO, Tableau, Cognos, SAS, SPSS, SQL).
• Experience in collecting, analyzing, summarizing, and formatting large data sets.
• Experience in narrative report writing.

Responsabilités

• Manage the unit’s data mining program, including proposals, development, and ROI analysis.
• Perform database queries to extract claims and related data for investigations.
• Analyze varied healthcare and financial data to identify fraud signals.
• Identify trends in claims data and financial records to detect fraud.
• Prepare reports and present findings to an investigative team.
• Prepare trial exhibits and testify as needed.
• Coordinate with Medicaid agency and managed care orgs on policy and info requests.

Connaissances

Data analysis

Audit

Healthcare fraud

SQL

Excel

Statistics

Communicate findings

Formation

Bachelor’s degree in Economics/Finance/CS

Outils

Excel

SQL

Tableau

SAS

Power BI

Description du poste

The Delaware Department of Justice is seeking an exceptional Senior Auditor to join the Medicaid Fraud Control Unit in the Fraud & Consumer Protection Division in the New Castle County office. The role focuses on providing auditing and data analysis expertise in health care fraud investigations and False Claims Act work.

You will work within a collaborative team, independently when needed, handling data mining, claims analysis, restitution calculations, and presenting findings.