Lead Analytics Consultant in Payment Fraud Analytics Team under Fraud Detection Services at Wells Fargo. Drive company credit culture and optimize fraud risk and payment strategies.
About the role
- Execution of health management projects and client health cost control. Promoting a culture of health and wellness within companies.
Responsibilities
- Execute strategic health management projects for the client portfolio aimed at controlling medical plan costs and promoting a culture of health and prevention within companies;
- Monitor hospitalization authorizations to track ongoing admissions and propose strategies for discharge and reduction of unnecessary hospital stays;
- Participate in health committees for key clients to analyze major risks in the health insurance policy and monitor implemented health actions;
- Conduct health studies, mapping major variances and their financial impacts to prioritize key risks and define action plans based on identified deviations;
- Provide technical support (analysis of medical claim denials, coverage under the ROL, and facilitating medical transfers with the insurer) requested by our clients;
- Discuss medical cases with the clients' medical teams.
Requirements
- Required qualifications:
- Degree in Nursing with active COREN registration;
- Intermediate knowledge of Microsoft Office (particularly intermediate Excel and PowerPoint);
- Experience in the health benefits market, medical auditing, brokerages, or health insurers/operators;
- Required skills:
- Analytical and clinical insight;
- Strategic thinking;
- Development of health indicators/KPIs;
- Ideal behavioral profile:
- Teamwork orientation;
- Conflict resolution skills;
- Good communication.
Benefits
- VITAL IS SYNONYMOUS WITH DIVERSITY!
- Inclusive environment
- Support for diversity
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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