Experienced Business Analyst – Fraud, Waste & Abuse

• Translate business needs into detailed UI mock-ups and requirements/user stories that guide development efforts
• Proactively identify opportunities for system enhancements or gaps that increase product value and operational efficiency based upon new industry trends/schemes or client need
• Define acceptance criteria and expected system behavior. Apply the test scenarios to execute User Acceptance Testing to verify that systems are functioning properly and business requirements are incorporated into the system design
• Participate in post-deployment testing sessions that occur after normal business hours (Typically one Thursday evening every month)
• Communicate effectively with both technical and non-technical audiences and capable of building and maintaining relationships with key stakeholders
• Create and maintain organized product project plans through integrated management tools to support product development (i.e., Azure DevOps or other tools)
• Utilize product knowledge combined with extensive Payment/Program Integrity subject matter expertise to lead requirement elicitation meetings with clients and stakeholders
• Configure and tailor client system environments (rules, alerts, case workflows, etc.)
• Deliver product demos, walkthroughs, and training as needed
• Develop and maintain internal & client training documents, job aids, and product enhancements/release notes
• Support daily product maintenance and client satisfaction

Requirements

• 5+ years of SME experience leading healthcare fraud and abuse detection and investigations
• 2+ years of experience in requirement elicitation, analyzing and documenting business processes and system requirements that are leveraged by development teams
• Certification: Professional certification as a Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) is desirable.
• Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
• Ability to clearly and concisely translate technical requirements to a non-technical audience.

Tools & Technologies

• Azure DevOps
• integrated management tools

Certifications & Qualifications

• Certified Fraud Examiner (CFE)
• Accredited Health Care Fraud Investigator (AHFI)