Job Description
Job Description: Data Analyst IICannot accept candidates that require work authorization sponsorship now or in the future. Work Arrangement: 100% RemoteSchedule: Monday–Friday, 8:00 a.m. – 5:00 p.m.Position OverviewThe Data Analyst II supports the Program Integrity team by analyzing healthcare claims data to identify and prevent fraud, waste, and abuse (FWA) within Medicaid programs. This role requires strong analytical skills, SQL proficiency, and experience working with healthcare claims data. The analyst will interact regularly with clients, engineers, and other internal teams to resolve operational issues and ensure high‑quality data outcomes.Key ResponsibilitiesWrite simple to intermediate SQL queries to extract data for client inquiries and research.Use production reports to research and assess overall data quality.Analyze healthcare claims data to identify trends, patterns, and potential FWA indicators.Engage with clients to triage, manage, and resolve incoming operational inquiries.Collaborate professionally with data engineers, software engineers, and other development teams.Troubleshoot client operational issues promptly and thoroughly.Conduct research, interpret complex datasets, and evaluate data quality.Utilize Excel and data visualization tools to support reporting and analysis efforts.Demonstrate proficiency with Microsoft Teams, Excel, Outlook, Word, and PowerPoint.Required Qualifications3+ years writing intermediate SQL queries.3+ years of experience with FWA data mining.3+ years of data analysis experience with database structures.3+ years of experience working with healthcare claims data.Preferred QualificationsIndustry certifications such as Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE).Experience performing statistical analysis on large datasets.Knowledge of Medicaid policy and real‑world FWA schemes.Familiarity with healthcare claim adjudication systems.Experience using Rally or similar work management tools.Project SummaryThe Fraud, Waste, and Abuse (FWA) Data Analyst plays a key role in protecting state Medicaid programs by identifying and analyzing fraudulent activity within claims data. The team supports multiple states through a state government FWA product, delivering 16 new algorithms per year, supporting new implementations, and maintaining ongoing client operations.Ideal Candidate ProfileA data‑focused professional with healthcare claims experience, strong SQL skills, and a CPC or CFE certification. Prior FWA experience is highly valued.Top Required Skills(All required)SQL (3+ years)FWA data mining (3+ years)Data analysis with database structures (3+ years)Healthcare claims expertise (3+ years)Candidate DifferentiatorsCuriosity and a strong willingness to learn.Ability to engage effectively with both technical and non‑technical stakeholders.Team Structure3 Data Engineers2 Report Developers (Power BI & Cognos)10 Data Analysts2 Managers1 DirectorAll supporting state government program integrity initiatives.Interview ProcessNumber of Rounds: 2Format: VideoTechnical Depth: General Q&A with analytical and SQL‑focused questions
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