CNO Financial Group Business Integrity Analyst in Carmel, Indiana
Under general technical direction, this role is primarily responsible for the research and analysis of high-risk transactions across all lines of business to identify possible fraud, waste and abuse activity. Interacts with internal and external customers to determine the appropriate actions required to mitigate losses. Documents and evaluates results of actions to support fraud, waste and abuse trending and reporting and ensure that best practices are followed.
Partners with the Special Investigation Unit (SIU) and Legal when the analysis presents probable cases that need further analysis. This role may exist across different areas (ORPM, Enterprise Ops, etc) and will partner across areas as needed.
Will be involved in the development and maintenance of the Business Integrity Framework including policies and procedures for identification, measurement, monitoring and mitigation of risks. Monitors and manages fraud, waste and abuse prevention and detection tool; acts as a primary resource for operational integrity interactions with vendor. Reviews information forwarded from both internal and external sources, including analyzing data from various business integrity alerts/software solutions. Summarizes key points of transactions in partnership with business associates/decision-makers and identifies trends and patterns to prevent future fraud, waste and abuse activity. May also be involved in root-cause analyses to isolate key fraud, misuse and abuse drivers. Maintains and administers fraud, waste and abuse prevention and detection tools. Identifies new tools and/or supports improved fraud prevention strategies. Escalates issues and emerging risks to manager. Develops and maintains a strong partnership with internal teams in Enterprise Operations, SIU and Legal. Gains understanding of claims processing practices, policy administration, policy language, state insurance regulations and applicable business practices. Determines appropriate action to conduct fraud, waste and abuse claim analysis and research. Discusses and develops risk mitigation plans and provides input into the implementation of those plans. Reviews and analyzes red flag reports. Partner with associates/decision-makers in other areas to determine appropriate follow-up to include corrective actions with claimants and full claim investigations. Reviews and determines the ongoing benefit eligibility of claimants under the terms of the insurance policy. Presents all possible fraud, waste and abuse cases to the Fraud, Waste and Abuse Detection and Prevention Roundtable, providing clear rationale for recommendations. Meets department, financial, and individual procedural/quality metrics/goals while adhering to all state and federal regulations, company ethics and integrity standards.
Intermediate to senior level with MS Excel
Prior experience in insurance or banking strongly preferred
Must desire to work identifying patterns and trend analysis in large data sets.
Report generation with tools such as Tableau strongly preferred.