SIU Intelligence Analyst

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Special Investigations Unit (SIU) Intelligence Analyst is responsible for providing proactive, data-driven intelligence to prevent and detect healthcare fraud, waste, and abuse in Medi-Cal, Medicare, and Covered California programs. This role bridges data science and investigations by conducting data mining, statistical trend analysis, and anomaly detection to validate leads and escalate high-impact patterns for formal investigation.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• Hybrid schedule
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Perform advanced data analytics and intelligence gathering to identify emerging fraud trends, organized schemes, and high-risk providers or claims. Conduct data mining and exploratory analytics to identify emerging fraud schemes, suspicious billing patterns, and provider/vendor anomalies.
2. Provide actionable intelligence, lead packages, and data visualization to SIU investigators in support of fraud, waste, and abuse (FWA) investigations.
3. Evaluate large datasets, including claims, medical records, provider enrollments, and utilization to uncover outlier behavior and systemic vulnerabilities.
4. Maintain SIU case documentation and track lead disposition to support audits and ensure regulatory readiness.
5. Build and maintain dashboards, reports, and risk detection models to identify and monitor healthcare fraud, waste, and abuse trends.
6. Prepare concise intelligence reports, presentations, and briefings for SIU leadership, Legal, Compliance, and operational teams.
7. Cross-functional collaboration with IEHP’s Business Units to validate lead data and support program improvement.
8. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• Required: Bachelor’s degree in Criminal Justice, Data Science, Healthcare Administration, Statistics, Business Administration, Public Health, or a related field from an accredited institution required.
  • Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred.
  • Advanced SAS Programmer certification preferred.

• Required: Minimum of three (3) years of experience in healthcare data analytics, FWA detection, or managed care compliance required. Experience with SQL and Power BI required. 
  • Preferred: Experience preferably in managed care. Strong preference for experience in fraud investigations, payment integrity, or compliance.
  • Prior experience in a health plan, government program, or investigatory agency SIU preferred.
    Experience with SAS, Tableau, or other data visualization tools preferred.

Key Qualifications

• Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred.
• Strong knowledge of CPT/HCPCS/ICD-10 coding, billing rules, and healthcare reimbursement models.
• Familiarity with claim data structure.
• Advanced Excel and Power Query skills.
• Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms is highly desirable.
• Exceptional analytical, problem-solving, and organizational skills.
• Excellent interpersonal and communication skills, capable of working effectively across various departments and with external partners.
• Strong judgment and risk assessment capabilities.
• Ability to interpret complex claims data and identify FWA red flags.
• Proven ability to work independently and as part of a team in a high-stakes environment.
• Ability to manage multiple projects with competing deadlines.
• Detail-oriented.
• Strong commitment to integrity and ethical decision-making.

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday - Thursday onsite in Rancho Cucamonga, CA.)