SIU Analyst II — Fraud, Data & Case Analytics

CoventBridge Group; United States; On-site; USD 74,000 - 87,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) match

PTO & holidays

Tuition assistance

Job summary

CoventBridge Integrity Systems is seeking an SIU Analyst II to conduct end-to-end fraud, waste, and abuse investigations. You will develop investigative plans, analyze data, and prepare defensible case files and reports to support recoveries and referrals.

The role requires current experience in SIU or program integrity, strong analytical and communication skills, and the ability to work independently on moderately complex cases while mentoring junior staff.

Qualifications

• College or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
• Candidates with Accredited Health Care Fraud Investigator (AHFI) and Certified Fraud Examiner (CFE) Certifications will be given priority consideration
• At least 1 year of experience in SIU, Program Integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions

Responsibilities

• Evaluate and develop leads, complaints, and/or investigations to determine if further investigation is warranted
• Execute assigned investigations from start to closure (post-triage), including strategy, documentation and recommendations
• Conduct interviews and outreach as required
• Build defensible case narrative and prepare findings report with clear overpayment/impact logic
• Utilize data analysis techniques to detect aberrancies in health plan claims data and develop leads/investigations
• Review information contained in standard claims processing system files to determine provider billing patterns
• Make potential fraud determinations using guidelines and regulations
• Compile and maintain documentation related to investigations, cases, and leads
• Participate in onsite audits in conjunction with investigation development
• Develop and prepare potential Fraud Alerts and program vulnerabilities for submission to clients, law enforcement
• Prepare and submit external correspondence and reports, including overpayment letters and referrals
• Prepare and submit correspondence to providers for medical record requests or suspension overpayment determinations
• Mentor CoventBridge Healthcare SIU staff

Skills

Data analysis

Investigation

Interviewing

Documentation

Regulatory compliance

Communication

Education

Criminal Justice

Statistics

Data Analysis

AHFI

CFE

Job description

CoventBridge Integrity Systems is seeking an SIU Analyst II to conduct end-to-end fraud, waste, and abuse investigations. You will develop investigative plans, analyze data, and prepare defensible case files and reports to support recoveries and referrals.

The role requires current experience in SIU or program integrity, strong analytical and communication skills, and the ability to work independently on moderately complex cases while mentoring junior staff.