Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Data Analyst, Special Investigations Unit

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Manager & Professional
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190GA Requisition #
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Design, implement and maintain the SIU data analytics database, Fraud and Abuse Management System (FAMS).  Identify potential fraud through outliers and targets through data analytics and data-mining.  Create and analyze data reports to support investigators’ position on case work.  Perform conversion of various data formats from different sources to meet specifications for both internal and external business partners.  Maintain the SIU Case Tracking and Allegation Tracking Databases.

Responsibilities:
  • Perform and maintain the FAMS data analytic database for the SIU.  Work as the liaison with IBM on version upgrades, reporting and maintaining the database.  Create, modify and testing reports and models on the database.
  • Design and identify potential fraud trends and schemes through data analysis and data-mining.  Prepare formal case studies to support the analysis.
  • Supports SIU staff by generating ad-hoc data reports.  Extract and convert data from various data sources to specifications as needed.
  • Assists and provide data reports according to specifications in response to subpoenas and requests for information from both external and internal sources.
  • Maintain the SIU case tracking and allegation databases.  These databases are housed in-house through an Access database.
Qualifications:
  • Bachelor’s degree in Computer Science, Mathematics or related major from accredited college or university
  • SQL or SAS coursework
  • Proficiency in programming and maintaining the IBM FAMS data analytics tool required
  • 3-5 Years of experience in data analytics, preferably in the healthcare industry required
  • Experience in data modeling and analysis required
  • Proficiency in SQL, COGNOS and SAS required
  • Strong knowledge of MS Access, Excel and Word required
  • Advanced knowledge of Access preferred
  • Strong analytical skills required
  • Knowledge of CPT, ICD-9, ICD-10 and HCPCS codes preferred
  • Knowledge of fraud trends and schemes required
  • Ability to identify and develop various Fraud, Waste and Abuse projects preferred
  • Ability to work independently preferred
  • Knowledge of NYS DOH and CMS regulations preferred

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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