SIU Data Analyst | Must Have a Background in Dental or Healthcare Insurance

At Liberty Dental Plan, we believe that protecting the integrity of our benefit programs is essential to making quality dental care more accessible. We’re seeking a detail-oriented and data-savvy SIU Data Analyst with a background in dental or healthcare insurance to join our Fraud, Waste, and Abuse team, to help us detect, analyze, and prevent fraud, waste, and abuse (FWA) within dental claims data. This is an opportunity to apply your analytical skills in a mission-driven environment and make a real impact on the health of our members and the integrity of our operations.

Job Summary

As the SIU Data Analyst, you’ll play a key role in Liberty’s Special Investigations Unit by leveraging advanced data mining techniques and statistical analysis to uncover suspicious activity and generate actionable leads for fraud investigations. In this critical role, you will:

• Extract, clean, and transform large datasets from multiple claims systems for analysis, ensuring data integrity and usability.
• Design and implement algorithms and SQL queries to identify unusual billing patterns, outliers, and anomalies in provider and member behavior.
• Perform exploratory data analysis to detect fraud indicators involving billing frequency, geographic clustering, or atypical utilization trends.
• Collaborate with SIU investigators and FWA managers to translate data findings into leads, case development, or targeted audits.
• Validate claims data associated with suspected fraud, waste, or abuse and support the development of claim refund projects.
• Create and maintain dashboards, reports, and visualizations that clearly communicate trends and analytical findings to stakeholders.
• Develop and track recoupment efforts for all data-mining-related investigations.
• Continuously improve fraud detection methodologies and contribute ideas to refine existing analytics processes.
• Stay current with industry trends in dental fraud detection and incorporate emerging techniques and external datasets to enhance Liberty’s strategy.
• Ensure data handling complies with HIPAA, internal policies, and regulatory requirements.

What You’ll Bring

• 3+ years of experience in data analysis, fraud detection, or healthcare claims analytics, preferably in a managed care or dental environment.
• Bachelor’s degree in Data Analytics, Statistics, Computer Science, Public Health, or a related field.
• Proficiency in SQL, Excel, and data visualization tools (e.g., Power BI, Tableau).
• Strong understanding of claims data, coding practices, and provider/member behavior.
• Demonstrated ability to detect patterns, anomalies, and fraud indicators using data mining and statistical techniques.
• Experience collaborating with investigative or audit teams in a healthcare or insurance setting.
• Clear, concise communication skills, with the ability to convey complex data findings to non-technical stakeholders.
• Knowledge of HIPAA compliance and data governance best practices.
• Experience in dental strongly preferred.

Preferred Skills

• Proficiency in Python with experience using libraries such as Pandas, NumPy, scikit-learn, Matplotlib, and PyODBC.
• Skilled in T-SQL with experience writing complex queries and stored procedures.
• Hands-on experience with data visualization tools, especially Power BI.
• Microsoft Certified: Power BI Data An