FWA Payment Integrity Data Analyst III, Health Plan, SQL

CareSource

. Lead and implement data analytic ideation and research-and-development activities and strategy supporting decision-making across multiple lines of business and clients .

Posted 11/10/2026full-timeRemote • United StatesSeniorLead💰 $83,000 - $132,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Healthcare Data Analytics, with a strong focus on Fraud, Waste, and Abuse (FWA) analysis, data visualization, and SQL programming. Proven ability to lead analytic initiatives, collaborate with vendors, and communicate complex data insights effectively.

Highest-signal resume keywords

Healthcare Data AnalyticsData Visualization / Dashboard ToolsSQL ProgrammingFraud, Waste, and Abuse AnalysisMedicare/Medicaid Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisSQL Data ManipulationDatabase DevelopmentInferential StatisticsData MappingHypothesis TestingDescriptive StatisticsGraphic DevelopmentAnalytic ProgrammingCoding Standards Knowledge

Soft Skills

Critical ThinkingDecision-MakingVerbal CommunicationWritten CommunicationTeam Collaboration

Tools & Technologies

Power BIMicrosoft SQL ServerTransact-SQLIntegration Services (SSIS)Microsoft ExcelMicrosoft AccessMicrosoft WordMicrosoft PowerPointSAS

Certifications & Qualifications

Coding Certification (AAPC or AHIMA Preferred)

Industry Keywords

Healthcare DeliveryPayer ExperienceMedicaidManaged CareBilling Rules and Regulations

Tech Stack

Tools & technologies

MS SQL ServerPythonSQLSSIS

About the role

Key responsibilities & impact

Lead and implement data analytic ideation and research-and-development activities and strategy supporting decision-making across multiple lines of business and clients
Validate Program Integrity vendor deliverables and results
Collaborate with Program Integrity vendors to understand and drive FWA analytic needs and results
Propose business solutions and communicate data analytics outcomes against goals and strategic plans
Participate in analytical, experimental, investigative, and fact-finding work supporting concept development and vendor collaboration
Monitor emerging internal and external FWA data vulnerabilities and trends and create risk-mitigation solutions
Identify trends and patterns using corporate processes, tools, reports, databases, and other data sources
Research policies, coding guidelines, and regulations supporting analytical hypotheses
Conduct outcome analyses to determine the impact and effectiveness of corporate and SIU initiatives
Examine and explain complex data relationships related to Fraud, Waste and Abuse
Generate graphics that describe, explore, and summarize analyses
Manage processes and reporting to ensure investigation-related claims are processed appropriately and timely
Collaborate with the Legal Department by generating data and analyses supporting legal proceedings
Perform data analyses supporting SIU Program Integrity and Audit Functions
Apply critical thinking and judgment to determine the best course of action for each inquiry or problem
Review reports and data for patterns, special-cause variation, trends, and associative or causal relationships related to Fraud, Waste and Abuse and Error
Provide management-level summaries explaining key findings and documentation for audits
Use descriptive statistics, sampling, and hypothesis testing to determine outcomes
Perform other job-related duties as requested

Requirements

What you’ll need

Bachelor's degree or equivalent years of relevant work experience in Healthcare Data Analytics required
Seven (7) years of experience in data analysis, FWA Ideation and/or analytic programming required
Seven (7) years of healthcare delivery and/or payer experience required
Extensive experience with Data Visualization / Dashboard tools (Power BI) required
Extensive experience using SQL for analytics projects, including database queries required
Three (3) years of experience with Medicare/Medicaid required
Healthcare management experience/exposure required
Clinical experience is preferred
Proven understanding of database development, including database relationships, data integration, SQL data manipulation, database object creation, database normalization, and dimensional design concepts
Insight in administering Microsoft SQL Server, Transact-SQL (ANSI-SQL), and Integration Services (SSIS) required
Insight and understanding of programming languages such as Microsoft Visual Basic and Python
Strong knowledge of coding standards, billing rules and regulations, and procedure and diagnosis codes (CPT, ICD10, HCPCS, APC and DRGs)
Proven analytic skills in solving multi-dimensional problems
Advanced experience with Microsoft Excel, Access, Word, and PowerPoint
SAS and SQL skills
Graphic development/presentation skills
Knowledge of inferential statistics
Working knowledge of descriptive statistical applications and techniques
Data mapping skills
Ability to document database and application design
Ability to maintain documentation of changes and modifications
Critical listening, thinking, verbal, and written communication skills
Decision-making/critical-thinking skills
Ability to work independently and within a team environment
Knowledge of Medicaid, Medicare, and managed care
Ability to lead analytic efforts
Coding certification through AAPC or AHIMA preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Employee total well-being support