Description
The Fraud, Waste and Abuse Operations Lead Analyst is responsible for administering operational efficiency processes that manage cost and optimize results, including financial data analysis and reporting as part of the Fraud, Waste and Abuse Program (FWA).
Key Responsibilities:
- Produce financial reports for clients and provide insights into trends
- Monitor and manage provider electronic withhold entries for audit recoveries
- Collect and analyze quality assurance data for public sector client meetings and internal metrics
- Ensure alignment and consistency of delivery of program between all benefits
- Identify emerging trends and create presentations for clients to support audit result meetings
- Work with internal and external stakeholders to address client inquiries and gather information
- Conduct monthly quality assurance review of staff time trackers
- Create and maintain forecasting tools for oversight on key performance indicators and emerging trends
- Oversee program training documents, SOPs, and working instructions
- Lead quality-focused remedial training sessions for the team
- Identify, lead, and manage special projects and program initiatives
- Continuously seek opportunities to create efficiencies within processes and drive value for the program
- Resolve non-routine issues escalated from other team members
Qualifications:
- Post-secondary degree or equivalent work experience
- 3+ years of related experience in Pharmacy and/or Dental Benefits Management, Group Insurance, or Health Care Operations
- Demonstrated experience in quality assurance activities, data analysis, and reporting
- Highly proficient in Microsoft Access & Excel, and data warehousing applications
- Experience with compiling, manipulating, or validating large pieces of data
- Ability to maintain electronic filing systems
- Display high levels of curiosity, integrity, tact, and objective judgment
- Excellent organizational, planning, and critical thinking skills
- Excellent verbal and written communication skills
- Proven interpersonal skills and ability to work well with senior management and high-level external contacts
- Ability to work with minimum management oversight on multiple projects with competing priorities
- Ability to work a flexible schedule in high-pressure environments with urgent deadlines
Benefits:
- Competitive compensation, benefits, and pension plan
- Career development and advancement opportunities
- A culture that celebrates innovation and collaboration
- Flexible work options and wellness programs