bowie, Maryland, United States
IDR is seeking a Senior SIU Analyst to join one of our top clients for an opportunity in Maryland. This role involves leveraging healthcare claims data and analytics to detect and validate fraud, waste, and abuse within the healthcare industry. The position is ideal for candidates with a strong investigative background in healthcare FWA and claims analysis.
Position Overview for the Senior SIU Analyst:
- Review healthcare claims flagged by fraud detection logic to determine validity.
- Analyze medical coding such as CPT, HCPCS, ICD-10, DRG, and APC to identify suspicious billing patterns.
- Work directly with raw or incomplete claims data to detect potential fraud without relying on existing dashboards.
- Collaborate with data scientists and product teams to enhance fraud detection algorithms.
- Present findings and recommendations to internal stakeholders based on thorough investigations.
Requirements for the Senior SIU Analyst:
- 4+ years of hands-on healthcare FWA investigative experience, preferably on the payer/health insurance side.
- Strong medical claims coding knowledge: CPT, HCPCS, ICD-10, DRG/APC.
- Experience starting from scratch with live or incomplete claims data.
- SQL or equivalent querying skills to analyze claims data independently.
- Familiarity with fraud detection rules and medical coding edits, including NCCI.
What's in it for you?
- Competitive compensation package
- Full Benefits; Medical, Vision, Dental, and more!
- Opportunity to get in with an industry leading organization.
Why IDR?
- 25+ Years of Proven Industry Experience in 4 major markets
- Employee Stock Ownership Program
- Dedicated Engagement Manager who is committed to you and your success.
- Medical, Dental, Vision, and Life Insurance
- ClearlyRated's Best of Staffing® Client and Talent Award winner 12 years in a row.
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