Blue Cross and Blue Shield of Minnesota · 8 hours ago
SIU Research Analyst Associate
Eagan, MN
Full-time
Hybrid
Mid Level
$60K/yr - $85K/yr
3+ years expBlue Cross and Blue Shield of Minnesota is committed to transforming healthcare and is seeking a dedicated individual for the SIU Research Analyst Associate role. This position involves performing technical and analytical work to support business solutions through research, database maintenance, and analysis of data related to Fraud, Waste, and Abuse (FWA) tips.
Insurance
Responsibilities
Performs reporting and data analysis for the department. Provides recommendations for improvements, and how to best achieve the desired business outcome
Monitor channels for incoming FWA tips regardless of channel (phone, email, mail or fax). This includes taking phone calls received through the internal SIU hotline phone number
Timely and accurately document/track all FWA tips received following departmental guidelines to ensure regulatory and business reporting is complete and accurate
Performs initial analysis and review of complaints through research and data analysis to accurately triage internal and external hotline tips to an SIU investigator or other business areas for resolution as appropriate with minimum supervision
Assists in the development of recommendations to solve routine or standard problems and issues related to business operations
Independently monitor, triage and assign incoming pre-pay claims and inquiry work as well as all SIU correspondence to appropriate investigator or other business area if misdirected to SIU
Process FWA settlement/recovery checks which includes identifying lines of business for which funds are recovered and preparing requests to operations and/or accounting to allocate funds to impacted accounts
Conducts research and evidence gathering for FWA investigations which can include data analysis, background research, internet searches and written requests for documentation. Prepares internal requests for document review to support FWA investigations
Gathers information from across divisions and from various levels of management to support completion of requests for information as well as internal, regulatory, and contractually required FWA reporting
Actively participates in assigned workgroups, committees, and project implementations
May prepare presentations to report findings to a supervisor or project leader
Qualification
Required
3+ years' related experience or Bachelor's degree. All relevant experience including work, education, transferable skills, and military experience will be considered
Ability to communicate with impact and skilled at delivering focused and compelling presentations
Proficient in Microsoft Word and Excel
Ability to make decisions based on analysis and business needs
Ability to bring a different perspective to situations and challenge the status quo
Must possess a strong work ethic and be flexible
Excellent organization and time management skills
Excellent verbal and written communication skills
Strong customer service and computer proficiency
Strong interpersonal communication skills
Must have knowledge of claims processing systems and coding and billing proficiency
Ability to use fraud data mining tools
Ability to work independently with excellent attention to detail
High school diploma (or equivalency) and legal authorization to work in the U.S
Preferred
Bachelor's degree
Knowledge of health insurance claims processing or customer service
Knowledge of health care nomenclature, claim coding and fraud, waste and abuse schemes
Benefits
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
Company
Blue Cross and Blue Shield of Minnesota
About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives.
1001-5000 employees
H1B Sponsorship
Blue Cross and Blue Shield of Minnesota has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
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2025 (4)
2024 (4)
2023 (6)
2022 (2)
2021 (3)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Carrie S. Lawrence
Executive Administrator to the President & CEO and Chief of Staff
Patsy Riley
Chief Goverment Officer and Senior Vice President and CEO, ClearStone Solutions
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