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Professional - Non-Clinical
Special Investigation Unit Analyst - The Health Plan
Houston, TX, US
We’re looking for a Special Investigation Unit Analyst, someone who’s ready to grow with our company. In this position you will be responsible for applying their knowledge and experience to support Special Investigation Unit's (SIU) regulatory compliance, analytical needs, investigative support, and other business needs. Represents the business area in strategic planning activities and provides recommendations based on best practices, benchmarking, data analysis and forecasting. Assists with the implementation, operation, and oversight of operational fraud and analytical applications, organizing internal and external data, responds to requests for information, and communicates recommendations to SIU management. Provides oversight for research, design, build, testing, deployment, analysis, administering, and maintaining environments.
Think you’ve got what it takes?
Job Duties & Responsibilities
• Ensures internal and external reporting is in compliance with relevant requirements
• Responds promptly and appropriately to internal and external questions/requests.
• Attends regulatory meetings to stay current on relevant regulatory requirements.
• Completes weekly, monthly, quarterly, yearly, and ad-hoc reporting needs.
• Utilizes departmental tools (schedules, meeting minutes, budget, standardized emails, and agendas) to maintain consistent, quality communication with customers.
• Facilitates internal communication and acquisition of needed data to compile and submit required reports.
• Monitors and ensures compliance with reporting submission deadlines and content of reports.
• Ensures regulatory order/requests for information management, oversight, documentation, and facilitating internal and external delivery/communication/fulfillment.
• Acts as the SIU liaison for internal and external entities including regulators, providers, members, internal departments, and other external entities.
• Maintain and operate, the operational fraud and analytical applications.
• Oversees the SIU fraud hotline, electronic mail referrals, and paper referrals that come into the SIU, additionally providing miscellaneous investigative support.
• Makes recommendations during continuous performance management processes and acts as a resource for the establishment of new projects.
Skills & Requirements
• Required High School Diploma or GED
• Preferred bachelor's degree Project Management, Business Management, Healthcare Management, Criminal Justice
• Preferred Certified Professional Coder (CPC) or similar
• Preferred Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering (AML), and Fraud Professional (CAFP) are advantageous
• Required 6 years Managed Care Organization Experience
• Previous 3 years Prior SIU Analyst, SIU Investigator, or equivalent experience
Please note: This is not a law enforcement, security officer or national security related position
Additional Note: This is a hybrid role, not a fully remote opportunity
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
