Summary

Under minimal supervision supports the continuous evaluation of the Department in alignment with Denver Health's financial, strategic, and operational initiatives and projects.  Evaluates business processes, anticipates opportunities and challenges, indentifies areas for improvement and makes data driven recommendations.  Coordinates and performs duties related to data acquisition and analysis for multiple projects simultaneously.

This position is responsible for the prospective and retrospective investigation of suspect claims and the development of fraud, waste, abuse and overpayment recovery cases.  This includes independently gathering, analyzing and interpreting complex data and information to provide meaningful results in developing leads, collaboration with internal resources as well as complying with state and federal requirements for fraud, waste and abuse detection and prevention.  Additionally this role assists in the training of new associates and in education to business areas to be on the alert for suspect claims or potentially fraudulent activity.

Full Job description

Experience

Two (2) years in data analysis, process improvement, or project management preferred. 

Experience in Health Insurance preferred. 

1. Bachelor's Degree required.  Concentration in business administration, finance, healthcare, or economics preferred.

2. Proficiency with Microsoft Office, specifically Excel required.  QNXT preferred.  Knowledge of relational databases (Microsoft SQL Server) and SQL preferred.