18 days old

Healthcare Analyst - Fraud

Coral Gables, FL 33134
  • Job Code

At IBM, work is more than a job - it's a calling: To build. To design. To code. To consult. To think along with clients and sell. To make markets. To invent. To collaborate. Not just to do something better, but to attempt things you've never thought possible. Are you ready to lead in this new era of technology and solve some of the world's most challenging problems? If so, lets talk.

Your Role and Responsibilities
The Healthcare Fraud Analyst will contribute to the development of predictive models to identify fraudulent Medicare/Medicaid providers and claims. You will be responsible for contributing to the work of a group of Medicare/Medicaid experts with fraud investigative experience and a clinical/medical background. You'll also interact with the client and team leaders to identify fraud vulnerabilities in Medicare/Medicaid claims billing, and support efforts to produce analytic results that fraud investigators can act upon. In addition, you'll also contribute to evaluating model performance and investigator use of the models, and developing methods for guiding investigators and prioritizing leads for investigators.

Required Technical and Professional Expertise
  • Ability to obtain and maintain a Moderate Risk Background Investigation (MBI) clearance.
  • Bachelors Degree or higher in business management or healthcare related field.
  • 8+ years experience in healthcare fraud investigative work.
  • 5+ years experience in preparing written reports (e.g., deliverables, publications).
  • 5+ years experience working in a project team environment or managing a project team.
  • 5+ years experience in working with federal clients in a consultative role.

Preferred Technical and Professional Expertise
  • Active Moderate Risk Background Investivation (MBI) clearance.
  • Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI).

About Business Unit
IBM Services is a team of business, strategy and technology consultants that design, build, and run foundational systems and services that is the backbone of the world's economy. IBM Services partners with the world's leading companies in over 170 countries to build smarter businesses by reimagining and reinventing through technology, with its outcome-focused methodologies, industry-leading portfolio and world class research and operations expertise leading to results-driven innovation and enduring excellence.

Your Life @ IBM
What matters to you when youre looking for your next career challenge?

Maybe you want to get involved in work that really changes the world? What about somewhere with incredible and diverse career and development opportunities where you can truly discover your passion? Are you looking for a culture of openness, collaboration and trust where everyone has a voice? What about all of these? If so, then IBM could be your next career challenge. Join us, not to do something better, but to attempt things you never thought possible.

Impact. Inclusion. Infinite Experiences. Do your best work ever.

About IBM
IBMs greatest invention is the IBMer. We believe that progress is made through progressive thinking, progressive leadership, progressive policy and progressive action. IBMers believe that the application of intelligence, reason and science can improve business, society and the human condition. Restlessly reinventing since 1911, we are the largest technology and consulting employer in the world, with more than 380,000 IBMers serving clients in 170 countries.

Location Statement
For additional information about location requirements, please discuss with the recruiter following submission of your application.

Being You @ IBM
IBM is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.



  • Computers Software and Hardware
Posted: 2020-01-03 Expires: 2020-02-02

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Healthcare Analyst - Fraud

Coral Gables, FL 33134

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