Head of Fraud/Waste & Abuse Analytics

Aetna   •  

New York, NY

Industry: Healthcare


11 - 15 years

Posted 34 days ago

Critical role leading the Fraud analytics team while partnering with Aetna's Special Investigation Unit (SIU). This individual will provide consultative, advisory services and outcomes for Fraud project driven initiatives (i.e. waste & abuse, payment integrity).
Acts as a key subject matter analytics expert and thought leader for a small team with a purpose driven focus: to uncover fraudulent activity.

Fundamental Components:
Consults with internal clients to identify opportunities to implement data science solutions to business problems at an expert level.
Acts as an analytics product owner translating business needs into analytics projects and actions.
Understands and recommends modeling techniques to data scientists.
Ability to structure data analysis, driving analytics insights and analytical solutions to help data scientists determine the best analytical solution.
Understanding key drivers of healthcare business value and being able to translate into business opportunities and frame them as analytical problems. eg How to grow business
Ability to translate business problems into analytical solutions by knowing appropriate models to suggest to data scientists.
Autonomously leads the client relationship with senior business leaders as their single point of contact.
Collaborates with business partners to understand their strategy, problems, and goals.
Works with senior leaders to identify opportunities to implement analytics solutions to business problems.
Presents recommendations to senior staff and internal clients. Seen as the face of the organization.
Mentors junior team members.
Consults on the creation of analytics solutions that effectively weigh business and technical tradeoffs using an expert understanding of business strategy as well as relevant big data environment topics.
Acts as an analytics product owner translating business needs into analytics projects and actions.
Resolves issues and removes barriers that hinder analytics initiatives. Builds contingency plans and executes corrective action on a timely basis to mitigate risks.
Sets priorities and executes strategy for the analytics organization.
Leads development of solutions with high complexity and risk with business area implications.

Minimum 10 years total healthcare analytics experience, in particular in Fraud (or Payment Integrity or Revenue Management)
5+ years experience strategy consulting or on strategy teams in large companies in Fraud Analytics
5+ years experience programming using R, Hadoop, or Python
5+ years of business experience leading analyses and initiatives with track record of business impact.
5+ years of people management experience Healthcare sector experience preferred
Demonstrates proficiency in most areas of mathematical analysis methods, machine learning, statistical analyses, and predictive modeling and in-depth specialization in some areas.
Experience in SAS or SQL or other programming languages.
Strong knowledge of advanced analytics tools and languages to analyze large data sets from multiple data sources.
Anticipates and prevents problems and roadblocks before they occur.
Demonstrates strong ability to communicate technical concepts and implications to business partners.

Master's degree required, PhD preferred.