Job Description

Strategic & Managerial Responsibilities:

• Support the execution of the health insurance cost containment strategy by delivering timely and accurate data insights that align with organizational priorities.
• Proactively identify opportunities to improve data processes, analytics workflows, and reporting tools to enhance fraud, waste, and abuse (FWA) detection capabilities.
• Collaborate with cross-functional teams to contribute to the development and refinement of fraud detection methodologies and healthcare cost optimization initiatives.
• Participate in continuous improvement efforts to elevate data quality and analytical rigor within MIAD Data Analytics.

Core Responsibilities:

• Develop, maintain, and enhance interactive dashboards and detailed reports using Power BI and other visualization tools to monitor provider, clinician, and member utilization patterns for FWA risks.
• Execute complex data extraction, transformation, and analysis workflows using SQL, Power BI, and scripting tools to detect abnormal utilization and potential waste.
• Work closely with senior data scientists to support advanced modelling efforts and ensure data consistency and integrity across analytics projects.
• Prepare clear, concise business insights and presentations that translate technical findings into actionable recommendations for leadership and operational teams.

Quality & Excellence Management:

• Monitor data quality and consistency in all reporting outputs, ensuring adherence to internal standards and regulatory requirements.
• Assist in the development and implementation of quality assurance procedures for data accuracy in reporting and analysis.
• Optimize and document analytics workflows to improve efficiency and reproducibility of results.
• Stay current on emerging FWA trends and healthcare data innovations to enhance analytical responsiveness and accuracy.

People Management Responsibilities:

• Provide guidance and training to business users on data visualization tools and self-service analytics platforms to promote data-driven decision-making.
• Collaborate with team members and stakeholders to facilitate knowledge sharing and support seamless execution of analytics projects.
• Assist in mentoring junior analysts or interns, contributing to their professional development and skill enhancement.

Preferred Educational Qualifications and Professional Certifications

• Bachelor’s degree required; strongly preferred fields are related to Computer Science or Programming, Statistics or Mathematics, Health Economics or Healthcare Management
• Master’s degree or PhD is preferred

Experience

• Minimum 3 years of experience in the healthcare industry data management or data analysis/reports/automations
• Minimum 3 years of experience in applying advanced analytical techniques to decision making in the healthcare/insurance industry incorporating some of the following skills: Data Analytics, Targeting, Optimization, Simulation, Decision Support, Statistics, and/or Mass-Data Analysis. Diversification and depth of subject matter excellence is preferred
• Experience working with medical coding using CPT4 and ICD10 and one of the following coding systems: UCLS, DRG, MOH, HCPCS or SRVC or similar healthcare methodology experience preferred
• Experience in FWA highly desired