Investigative Analyst Senior

About This Role

This role is responsible for analyzing complex business problems using extensive knowledge of applications, data, technologies, and analytical methods to support department objectives. It involves analyzing healthcare, business system, and financial data to identify patterns of suspicious activity and risks, requiring a high level of critical thinking.

Responsibilities

• Serve as the point of authority in the analysis of complex healthcare, business systems, and financial data
• Perform complex data mining and ad hoc data analysis to identify and quantify patterns of suspicious activity, outliers, anomalies and other issues that represent risk
• Develop and utilize complex analytic outputs and/or services, including predictive models, decision trees, forecasting and optimization analysis
• Develop requirements for analysis and reporting solutions to support Department business objectives
• Develop complex databases, queries, and reports
• Perform database and dataset updates
• Utilize multiple corporate data repositories, including SQL Server and Oracle databases to extract information
• Use management reporting tools to provide business intelligence required to make effective decisions
• Complete analysis and reporting utilizing a variety of applications (Access, ACL, SQL Server, Oracle, Facets, and PeopleSoft)
• Read and interpret design document conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts
• Identify risks and multiple solutions
• Recommend and implement improvements to existing procedures and influence others to follow them
• Make technical and functional business recommendations based on evolving technologies and application trends
• Analyze business system configuration data to identify complex patterns of suspicious activity, outliers, anomalies and other issues that represent risk
• Address business challenges to improve efficiency and decision making, reduce redundancy, and ultimately enhance business results
• Apply advanced statistical knowledge to perform sampling, extrapolation and forecasting techniques
• Function as a liaison between own department, health plans, functional areas, and ITS, collaborating directly with associates, other departments, and external constituents to analyze data, identify trends, and communicate findings
• Train associates in data analysis
• Serve as a subject matter expert to less experienced associates in data sources, analysis, query, database, application, and reporting
• Continue to improve technical skills and stay current with changes in corporate data resources, company initiatives/objectives, tools and applications

Requirements

• Extensive knowledge of applications, data, associated technologies and/or analytic methods to support Department objectives
• High level of critical thinking and analysis
• Strong knowledge of a structured query language (e.g. MS Access, VBA, T-SQL, or PL/SQL)
• Advanced statistical knowledge to perform sampling, extrapolation and forecasting techniques
• Strong demonstrated experience in developing MS Access databases and SQL Server solutions
• 3+ years related experience in statistics, actuarial analysis or medical profiling

Qualifications

• BA/BS in computer science, finance, economics, statistics, mathematics, business administration, information systems, operation research, accounting or related analytical discipline
• Minimum of 3 years related experience in statistics, actuarial analysis or medical profiling; or any combination of education and experience, which would provide an equivalent background.

Skills

* Required skills

Benefits