SIU Analyst/Investigator
Job Summary
We are seeking a detail-oriented SIU Analyst/Investigator to join our team. In this role, you will play a crucial role in ensuring the accuracy, compliance, and integrity of healthcare claims through comprehensive audits, analyses, and process improvements. The SIU Investigator (Analyst) primary responsibility is to detect, investigate, and produce change in aberrant behavior observed in our healthcare customer's claims and enrollment data. You will work both independently and with a team of clinical SMEs to analyze data, assess exposure, and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting for FWA recoupments and savings.
Key Responsibilities
- Identify and conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)
- Participate in the development and presentation of FWA-related education for assigned Customers
- Perform coding reviews for flagged claims, to support Coding team (if applicable).