Data Analyst II

As a Data Analyst II, you will conduct thorough evaluations and advanced analyses of potential fraud cases and data inquiries by leveraging claims information and multiple data sources. Provide critical support in developing complex, high-value, or sensitive cases that warrant referral to law enforcement, recovery of overpayments, or administrative action-driven by both proactive and reactive data analysis strategies. In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity Systems’ objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. The Data Analyst II position will report directly to the Data Analysis Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office. Responsibilities/ Requirements, * Perform comprehensive analysis of healthcare claims data using advanced statistical and analytical methods; prepare clear, concise, and well-structured reports summarizing key findings.

• Collaborate with management, investigators, and analysts to support both proactive and reactive case development efforts by fulfilling data requests.
• Apply techniques such as data mining, statistical modeling, and predictive analytics to identify anomalies in Medicare/Medicaid claims; proactively generate leads and build cases from sources including CMS, OIG, fraud alerts, and various government or private referrals.
• Validate analytical outputs and identify potential fraud, waste, or abuse in alignment with Medicare/Medicaid regulations, policies, and guidelines.
• Communicate analytical insights effectively to internal stakeholders and external partners, including law enforcement agencies.
• Respond to management requests related to CMS reporting requirements with timely and accurate data support.
• Contribute to the development and delivery of training sessions for providers, beneficiaries, staff, and law enforcement on fraud, waste, and abuse detection through data analysis.
• Demonstrate strong organizational skills and manage multiple tasks efficiently while adhering to strict timelines.
• Ensure the integrity and security of all documentation by maintaining proper chain of custody and following confidentiality protocols.
• Adhere to all required documentation standards and reporting procedures as defined by internal and external guidelines.
• Perform other duties as assigned

• Bachelor’s or Master’s degree in Mathematics, Statistics, Health Informatics, Data Science, or a related field.
• Minimum 2 years’ experience analyzing Medicare and/or Medicaid data.
• Minimum 2 years’ experience in SQL and Python.
• Working knowledge of SAS, Databricks, Snowflake, or Spark.
• Experience with libraries like Pandas, NumPy, Scikit-learn, or visualization tools like Seaborn, Matplotlib, Tableau, or Power BI.
• Strong understanding of healthcare claims, ICD codes, provider identifiers, and Medicare/Medicaid billing practices.
• Exceptional organizational, communication, and problem-solving skills., * Experience working with any state Medicaid agency, Medicaid Administrative Contractor, or Unified Program Integrity Contractor (UPIC).
• Experience in transitioning from SAS to more modern tools (e.g., Databricks, Snowflake).
• Familiarity with CMS reporting and fraud detection protocols., * Bachelor’s Degree in Mathematics, Statistics, Healthcare Administration, Data Science, or related discipline with preference given to MA or MS recipients, and/or relevant work experience as a data analyst
• 2+ years of SQL or SAS development experience as well as demonstrated knowledge of healthcare and claims, or a combination of education and equivalent work experience
• Demonstrated knowledge of various database management systems in order to input, extract or manipulate information
• Demonstrated experience and knowledge of healthcare information (health claims data; specifically, Medicare and Medicaid, ICD-9-CM and ICD-10-CM codes, physician specialty codes, pharmaceutical data, provider identifiers, etc.) is preferred

Pulled from the full job description Tuition reimbursement Health insurance 401(k) matching Paid time off Vision insurance Dental insurance Disability insurance, * Medical, Dental, Vision plans

• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

The salary range for this role is $80,000 to $90,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)

CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.