Data Analyst II

Overview

Data Analyst II – REMOTE

Company Overview

CoventBridge Group is the leading worldwide full-service investigation firm. We provide superior data analytics and investigative solutions to government and commercial clients, helping to detect and prevent fraud, waste, and abuse in healthcare. We are expanding our Data Analysis team with a strong focus on emerging technologies like Python, Databricks, and Snowflake.

Position Summary

As a Data Analyst II, you will conduct thorough evaluations and advanced analyses of potential fraud cases and data inquiries by leveraging claims information and multiple data sources. Provide critical support in developing complex, high-value, or sensitive cases that warrant referral to law enforcement, recovery of overpayments, or administrative action—driven by both proactive and reactive data analysis strategies.

The Data Analyst II position will report to the Data Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.

Key Responsibilities

• Perform comprehensive analysis of healthcare claims data using advanced statistical and analytical methods; prepare clear, concise, and well-structured reports summarizing key findings.
• Collaborate with management, investigators, and analysts to support both proactive and reactive case development efforts by fulfilling data requests.
• Apply techniques such as data mining, statistical modeling, and predictive analytics to identify anomalies in Medicare/Medicaid claims; proactively generate leads and build cases from sources including CMS, OIG, fraud alerts, and various government or private referrals.
• Validate analytical outputs and identify potential fraud, waste, or abuse in alignment with Medicare/Medicaid regulations, policies, and guidelines.
• Communicate analytical insights effectively to internal stakeholders and external partners, including law enforcement agencies.
• Respond to management requests related to CMS reporting requirements with timely and accurate data support.
• Contribute to the development and delivery of training sessions for providers, beneficiaries, staff, and law enforcement on fraud, waste, and abuse detection through data analysis.
• Demonstrate strong organizational skills and manage multiple tasks efficiently while adhering to strict timelines.
• Ensure the integrity and security of all documentation by maintaining proper chain of custody and following confidentiality protocols.
• Adhere to all required documentation standards and reporting procedures as defined by internal and external guidelines.
• Perform other duties as assigned

Required Qualifications

• Bachelor’s or Master’s degree in Mathematics, Statistics, Health Informatics, Data Science, or a related field.
• Minimum 2 years’ experience analyzing Medicare and/or Medicaid data.
• Minimum 2 years’ experience in SQL and Python.
• Working knowledge of SAS, Databricks, Snowflake, or Spark.
• Experience with libraries like Pandas, NumPy, Scikit-learn, or visualization tools like Seaborn, Matplotlib, Tableau, or Power BI.
• Strong understanding of healthcare claims, ICD codes, provider identifiers, and Medicare/Medicaid billing practices.
• Exceptional organizational, communication, and problem-solving skills.

Preferred Qualifications

• Experience working with any state Medicaid agency, Medicaid Administrative Contractor, or Unified Program Integrity Contractor (UPIC).
• Experience in transitioning from SAS to more modern tools (e.g., Databricks, Snowflake).
• Familiarity with CMS reporting and fraud detection protocols.

Benefits

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

The salary range for this role is $60,000 to $75,000 annually.