Freelance Payment Integrity Consultant @ London, England
6 Month Contract
3-5 days per week
£400-£500 per day
The Consultant will work within the team of Payment Integrity which focuses on the identification, prevention and recuperation of medical claims; and reduction of unwarranted claims expenditure by controlling fraud, waste and abuse. The main focus of activity will be the utilization of advanced analytics, including machine learning, to detect outliers in our Hospital/Medical Consultant/Claims population. The consultant will also further build upon internal capability in identifying ineligible payments, with a view of putting in measure to minimize future occurrences of this type. This can include fraud, over servicing and payments made outside of product policies.
The consultant will not only be implementing new methodologies which will deliver real value to our business through claims savings, but also up-skilling the internal analytical teams. While the initial applications of these techniques will be in fraud and claims leakage the potential uses of these techniques extends to other areas of Health Risk Management, both in the UK and potentially across the globe.
Accountabilities & Activities:
- Work with the Analytic Manager to develop Analytic plans, methods used, tasks and timelines.
- Designs, recommend, execute and oversee Analytic Projects.
- Complete ad-hoc projects relating to data investigations or follow-ups on analysis results.
- Develop good working relationships across departments, especially the Benefits Investigation team, to translate findings into operational processes
- Document tasks on a timely and accurate basis including delineation of tasks and estimation of effort. Provide project details and status updates to support project scheduling and workload management.
- Collaborates with other departments
- Works with more junior stuff and provides direction and expertise.
- Timely communication and escalation of operational issues to the appropriate resource for resolution.
- Collaborate with fellow team members on individual tasks.
- Support data and process investigations and recommend and help implement the preferred solution.
- Present results to internal or external audiences including senior teams.
Qualifications, Training & Experience:
- 3-6 years of related experience in fraud, waste and abuse analytics
- Subject Matter Expert in the area of fraud, error and leakage analytics
- Experience in implementing proactive fraud techniques including network analysis
- Programming skills (SQL/SAS) desirable but not essential
- Expert command of an Advanced Analytics platform (SAS EM, R, Python or similar)
- Understanding of healthcare data and key concepts of the PMI business desirable but not essential
- Proficient in Microsoft Office suite, especially Excel and PowerPoint.
- Ability to analyse and solve complex problems
- Ability to prioritise and handle multiple tasks simultaneously.
- Self-motivated individual.
- Strong work execution: Ownership of individual tasks and the ability to work independently and as a member of a team.
- Ability to provide input into, feedback on, and follow a project schedule.
- Ability to teach technical concepts, present to small groups.
- Excellent verbal and written communication skills, organisational skills, interpersonal skills, as well as problem-solving and critical thinking skills.
- Professional maturity.