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Civil Fraud Analyst/Data Analyst

Expired Job

SGI Global, LLC Knoxville , TN 37902

Posted 3 months ago

SGI Global is seeking a Civil Fraud Analyst/Data Analyst for the United States Attorney's Office (USAO) for the Eastern District of Tennessee). The Civil Fraud Analyst will assist with the district's efforts in investigating qui tam complaints and other civil corporate fraud matters. The position is based in Knoxville, Tennessee.

This position is contingent upon contract award

Responsibilities

The Civil Fraud Analyst will work under the direction of the Project Task Leader. The Civil Fraud Analyst shall provide services to include, but not limited to the following, while complying with established procedures.

  • Provide comprehensive claims analysis for all Affirmative Civil Enforcement (ACE) matters.

  • Isolate claims billed with a given modifier and determine what other services were billed with those claims as part of assessing possible inappropriate use;

  • Identify possible outlier billings within specific codes, which are the payment driver for health care claims;

  • Normalize claims data across several health benefit plans in order to perform a time study or other assessment of the claims, such as identifying the day of the week a provider visits a skilled nursing facility;

  • Identify trends or other data within records obtained through investigation or discovery and use that information to test the data for various conditions;

  • Re-interpret (extrapolate) results of a Statistically Valid Random Sample if changes are made to the sample review results; and

  • Develop and defend loss calculation methodologies.

  • Actively communications with witnesses, persons of interest, and local/state/federal agency representatives to gather facts, collective sequence of events, statements and perform overall investigations.

  • The Civil Fraud Analyst will be able to examine documents such as financial records, reports, various correspondence, and computer data in to establish fact patterns verify or create relationships between new and existing facts/parties/evidence. The Civil Fraud Analyst will also provide attorneys with investigative plans and conclusions necessary for successful litigation. Additional duties may include authenticate documents, evidence, corroborate witness statements, reports, and assessments.

  • Devises methodologies for obtaining evidence, evidence preservation, and trial presentation of evidence.

  • Provides recommendations and overall assistance to AUSAs on document compilation, physical evidence, demonstratives, and audio-visual materials that may be used for motions or trial.

  • Must be able to analyze fact patterns and communicate findings to AUSAs.

  • Assists in obtaining documents and other information related to cases.

  • Performs research to locate potential witnesses.

  • Conducts in-house, telephone and database research; manages case file.

  • Some travel may be required.

Qualifications

  • Experience in document analysis, particularly in relation to fraud cases.

  • Must have a Bachelor's degree and 2+ years' experience in performing on-line database research and telephone research.

  • Working knowledge of various public repositories of information.

  • Desired experience with Medicare/Medicaid claims, student loan programs, and DOD contracting.

  • Familiarity with interviewing witnesses, investigative processes, Online Research tools such as LexisNexis and or WestLaw).

  • Investigative or Law Enforcement Background helpful.

  • Excellent oral and written communication skills

  • Strong analytical skills are extremely important.

  • Familiarity with automated litigation support helpful

  • Ability to meet fast approaching deadlines.

  • Must be able to work well in a team setting.

  • Must be able to lift case files that weigh 40 pounds.

  • Must be a United States citizen.

  • Ability to successfully pass a Minimum Background Investigation (BI, Level 6) prior to starting work.

SGI Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.


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Civil Fraud Analyst/Data Analyst

Expired Job

SGI Global, LLC