[Hiring] Senior Analyst @Lucet

Role Description

The Sr Analyst, Healthcare Fraud, Waste and Abuse will be a business consultant to the rest of the organization in providing reports and analysis to support Lucet’s Program Integrity and Fraud, Waste and Abuse prevention. In addition, the analyst is responsible for:

• Translating evaluation questions into analytic plans.
• Constructing analytic datasets.
• Producing appropriate data summaries.
• Conducting valid data comparisons and statistical tests.

What You Will Do - Essential Functions

• Reporting & Fraud, Waste & Abuse Analytics:
  • Lead and expand reporting and analytics programs to generate insights and drive actions supporting Program Integrity and Fraud, Waste & Abuse (FWA) prevention.
  • Perform detailed claims trend and drill-down analyses to identify actionable FWA risks across member/provider populations and cost categories.
• Population Health & Strategic Analysis:
  • Partner with clinical strategy teams to define intervention and comparison cohorts, develop valid performance measures, and ensure appropriate use of enterprise data.
  • Serve as a population health consultant by profiling member populations, identifying opportunities for new service offerings, and projecting savings through multivariable analysis.
• Cost Management & Financial Impact Assessment:
  • Identify cost-saving opportunities through analysis of care utilization, practice patterns, negotiations, and contract performance, while recommending improvements to reduce cost of care.
  • Evaluate the financial impact of contracts, RFPs/RFIs, and operational initiatives, providing data-driven recommendations and reporting to support management decision-making.

Qualifications

• Bachelor's Degree.
• 5+ years of experience in a similar role at healthcare payer or provider organization.
• Familiar with common statistical methods including but not limited to regression, propensity matching, and analysis of variance.
• Proficiency in database query language (e.g. SQL, SAS).
• Experience with software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau, PowerBI) and analytic automation (e.g. scripting, macros).
• Experience with enterprise data warehouse and commercial/Medicare/Medicaid claims data.
• Ability to read, analyze and interpret technical materials and financial data.
• Must be able to present information in a small group setting with internal and external customers.
• Ability to perform complex arithmetic and intermediate algebra to set up spreadsheets and reports.
• Creates reports using advanced graphical skills which can be quickly understood by the customer.
• Ability to pass background check upon hire and throughout employment.

Requirements

• Someone who embodies our values by:
  • Serving everyone with compassion and leading with empathy.
  • Stepping up and creating value by taking charge and acting when there is an opportunity.
  • Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
  • Nurturing growth and belonging by respecting and celebrating everyone for who they are.
• Practical problem-solving abilities.
• Strong analytic and data management skills.
• Strong oral and written communication and presentation skills.
• Ability to work both independently and as part of a team.
• Ability to work well with individuals at all levels within the institution.
• Ability to appropriately scope and execute evaluation and analysis work.
• Responsible with a high level of integrity and ethical standards.
• Intuitive nature to identify compliance irregularities.
• Excellent communication and interpersonal skills, with the ability to collaborate across teams.

Working Conditions

• High-speed internet service (cable or fiber optic) with minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds required.
• Frequent use of computer and phone systems.
• Must be able to constantly remain in a stationary, sitting position.
• Work is performed from home with company-provided equipment.
• A quiet workspace with minimal background noise for calls.