ABOUT THE ROLE

Under the direction of the Director of Compliance, the Senior Analyst, Special Investigations Unit (SIU) will work to prevent, detect and investigation known or suspected acts of fraud across Bright Health’s various lines of business. The Senior Analyst will be responsible for coordinating investigation activities, building the Bright Health SIU program/shared service function, and contributing to the development and administration of Fraud, Waste, and Abuse (FWA) analytical tools. 

YOUR RESPONSIBILITIES

• Intake and review reported instances of suspected fraud, waste, and/or abuse
• Perform investigations of credible instances of suspected fraud and coordinates communication with all parties involved and external regulatory and law enforcement agencies, as necessary
• Prepare reporting for internal analysis and external reporting requirements
• Develop tools, templates, and strategies to proactively analyze data and identify potential FWA trends
• Contribute to the SIU shared service program development
• Fulfill response requests for Requests for Information (RFI) and other external requests from state and federal regulators, attorneys, and other entities as necessary
• Provide FWA training and contribute to the develop of FWA training materials at Bright Health

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree required
• At least one of the following: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering and Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar certification/credential
• At least three to five (3 to 5) years of experience performing SIU investigations at a healthcare company
• Health insurance experience preferred

PROFESSIONAL COMPETENCIES

• Strong attention to detail
• Excellent oral and written communication skills, including experience with technical writing
• Ability to gather and analyze data sets
• Strong presentation skills
• Ability to work collaboratively with both internal and external stakeholders
• Knowledge of the health care regulatory landscape as it applies to FWA; health plan experience preferred
• Experience with HIPAA and data privacy/security

LICENSURES AND CERTIFICATIONS

• At least one of the following: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering and Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar certification/credential

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together. 

We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!