Grow your career at APWU Health Plan
Financial Analyst – Audit & Compliance
The APWU Health Plan is seeking a Financial Analyst – Audit & Compliance to join our Finance and Administration Division. This position coordinates, supports and oversees all aspects of external financial, operational and regulatory audits to ensure compliance with applicable accounting standards, contractual requirements, and government regulations.
RESPONSIBILITIES
- Monitors accounting policies, procedures and practices to ensure compliance with applicable laws, Generally Accepted Accounting Principles (GAAP), and regulatory changes.
- Manages the accounting, financial reporting, and compliance activities for the Employee Staff Pension Plan, Management Staff Pension Plan, Health and Welfare Trust, Life Insurance Plan and Health Insurance Plan.
- Prepares and records journal entries related to the Federal Plan, the Pension Plans, and Post-Retirement Benefit Plans.
- Prepares bank, investment and account reconciliations for the and Pension Plans, and the Health and Welfare Trust.
- Completes financial statements for the Pension Plans and the Health and Welfare Trust.
- Reviews proposed audit adjustments, reclassifications and findings; assists in evaluating recommendations and coordinating responses with external auditors.
- Monitors the status of audit findings, recommendations, and corrective action plans to ensure timely resolution and compliance with established deadlines.
- Provides back-up support to the Staff Accountant II and the Senior Staff Accountant for Payroll and A/P, respectively.
- Administers plan personnel policies/CBA accurately and equitably.
- Updates unit procedures on a timely basis.
- Performs other duties as assigned.
QUALIFICATIONS
- BS Degree in Accounting or Finance or equivalent combination of accounting coursework and experience
- Minimum 3-5 years’ experience in audit, accounting, or in a governmental accounting position.
- Working knowledge of the Federal Acquisition Regulations (FARS) and governmental accounting experience is desirable.
- Must be capable of obtaining/maintaining government clearance through OPM.
- Excellent analytical and organizational skills
- Strong verbal and written communication skills
- Proficient in Microsoft Office Products; Ability to learn new software programs.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
FWA Clinical Investigator
The APWU Health Plan is seeking a FWA Clinical Investigator to join our Finance and Administration Division. This position audits clinical documentation and healthcare claims to identify billing irregularities, coding inaccuracies, and suspicious billing patterns. This role plays a critical part in strengthening the operation and cost-effectiveness of the health plan’s FWA program by preventing improper payments and recovering lost revenue.
RESPONSIBILITIES
- Review electronic medical records (EMRs), clinical notes, itemized bills, and provider documentation to ensure validity, accuracy, and clinical justification of billed services.
- Analyze complex healthcare claims data to uncover suspicious provider billing behaviors, including upcoding, unbundling, duplicate billing, phantom billing, and overutilization.
- Draft evidence-based, detailed audit summaries, case briefs, and clinical rationales to support overpayment recoveries, provider corrective action plans, or referrals to OPM/OIG.
- Partner closely with investigators, data analysts, to build comprehensive evidence files for ongoing healthcare fraud investigations.
- Serve as the clinical subject matter expert for non-clinical investigators, translating complex medical workflows, documentation nuances, and provider notes into clear, actionable investigative leads.
- Other duties as assigned.
QUALIFICATIONS
- An associate or bachelor’s degree in health information management, Nursing, Healthcare Administration, Medical Coding, Criminal Justice or related healthcare field.
- Five plus years if experience performing clinical documentation reviews.
- Must have experience with fraud, waste and abuse investigations, claims auditing of medical and behavioral health services and utilization review.
- One of the following Certifications preferred:
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Registered Health Information Technician (RHIT)
- Registered Health Information Administrator (RHIA)
- Certified Fraud Examiner (CFE)
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Professional Medical Auditor (CPMA)
- Demonstrated proficiency with Microsoft Office 365 including Excel, PowerPoint, Outlook, SharePoint and Word.
- Must have knowledge of federal and commercial insurance regulations as well as healthcare compliance requirements (HIPAA, OPM/OIG guidelines, CMS regulations).
- Experience with Electronic Medical Records (EMR/HER) system and claims processing systems as well as data analysis and reporting tools.
- Ability to define data and information needs; compile, analyze and interpret data relative to healthcare utilization.
- Ability to identify documentation inconsistencies and billing irregularities.
- Knowledge of medical terminology, CPT and ICD10 coding, investigative techniques, analytical methodologies, and insurance and claim operations.
- Highly organized, motivated self-starter with strong analytical, critical-thinking, attention to detail and problem solving skills.
- Excellent computer skills to include Microsoft Office, Healthcare Fraud Shield software suite, QNXT software suite, savvy internet research skills and Ad hoc query and reporting.
- Excellent analytical, verbal and written communication skills.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Senior Program Manager, Procurement and Contract Administration
APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking a Senior Program Manager, Procurement and Contract Administration, to join our Compliance Department.
The Senior Program Manager, Procurement and Contract Administration, establishes and administers a centralized contract procurement function for the Health Plan. The role serves as the primary point of contact for solicitation support, contract initiation, vendor documentation, contract file maintenance, procurement compliance tracking, contract renewals, and related administrative activities in accordance with established policies, procedures, budget requirements, and applicable regulatory guidelines.
RESPONSIBILITIES
Coordinates and administers contract procurement activities, including requests for proposals, requests for quotes, vendor questionnaires, bid documentation, and related solicitation materials for general contractual agreements.
Receives, organizes, and tracks vendor responses, proposals, quotes, required forms, certifications, insurance documents, business documents, business associate agreements, and other procurement-related submissions.
Maintains complete and accurate contract procurement files, including solicitation records, vendor communications, evaluation materials, approval documentation, contract drafts, amendments, renewals, and executed agreements.
Coordinates with business owners to document contract needs, scopes of services, vendor requirements, timelines, and support documentation required for procurement review.
Tracks contract terms, expiration dates, renewal deadlines, notice requirements, service commitments, pricing provisions, and required follow-up actions to ensure timely review by business owners and management.
Manages contract review with operational functions in Finance, Compliance, and Information Technology, and support vendor selection and award documentation by organizing evaluation materials, pricing comparisons, decision-support records, and required approvals.
Identifies contractual requirements, potential conflicts, and compliance or operational impacts; ensure that all terms align with OPM regulations, policies, and procedures.
Coordinates signatures, amendments, extensions, renewals, and related documentation before contract execution or continuation.
Ensures that vendors complete required business associate agreements and coordinate with Vendor Compliance staff on risk management activities before contracts are fully executed.
Monitors vendor performance documentation and assists with follow-up on contract deliverables, service concerns, outstanding documentation, pricing discrepancies, and administrative issues.
Prepares contract procurement status reports, renewal schedules, vendor summaries, contract tracking reports, spending information, and other reports requested by management.
Maintains confidentiality of contract terms, vendor information, pricing, financial records, internal evaluations, and procurement-related documentation.
Participates in audits, contract reviews, procurement process improvement initiatives, vendor management activities, and other departmental projects related to contract procurement administration.
Performs related duties as requested.
QUALIFICATIONS
Bachelor’s degree in business administration, procurement, contract administration, public administration, or a related field preferred; equivalent work experience may be substituted.
Minimum of five years of experience in contract procurement, contract administration, vendor coordination, or a related procurement and contract management function required.
Knowledge of FEHB, PSHB, Medicare, Medicaid, FEDVIP, or similar government-sponsored healthcare programs preferred. Applied knowledge in a business healthcare setting of quality improvement, research, and statistics.
Knowledge of contract procurement practices, solicitation documentation, vendor submissions, contract file maintenance, renewal tracking, purchase order linkage, and basic budget controls. In addition, ability to review contract procurement documents for completeness, accuracy, required approvals, dates, terms, pricing provisions, renewal language, and supporting information.
Demonstrated ability to analyze complex information, develop solutions and implement effective courses of action for contract execution, including coordination with vendor compliance staff on complementary activities.
Strong organizational skills and ability to manage multiple solicitations, contracts, renewal dates, documentation requests, deadlines, and priorities. Attention to detail and proficiency in maintaining accurate procurement records and databases.
Ability to maintain confidentiality and exercise discretion when handling vendor, pricing, financial, business, internal evaluation, and contract information.
Proficiency with Microsoft Office applications, including Word, Excel, and Outlook; ability to learn contract management, procurement, finance, and document management systems.
Strong communication skills required, including the ability to effectively communicate verbally and in writing, internally and externally, and at different levels as necessary.
Extensive knowledge of regulatory requirements and ability to adapt to changing regulations and organizational needs while maintaining compliance.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
AI Data Business Analyst
APWU Health Plan, a non-profit organization located in Elkridge, MD, is seeking an AI Data Business Analyst to join our Information Technology Division.
The AI Data Business Analyst plays a critical role in translating business needs into data driven, AI enabled solutions that will drive strategic decisions across the APWU Health Plan.
RESPONSIBILITIES
Business & Data Analysis
- Partner with business stakeholders to understand operational challenges and translate them into clear data and analytics requirements.
- Analyze large, complex datasets to identify trends, risks, and improvement opportunities.
- Develop business cases and ROI narratives for analytics and AI initiatives that improve efficiency, reduce errors, or enhance member experience.
AI & Advanced Analytics Enablement
- Collaborate with IT to produce analysis dashboards, to create visualizations for the organization.
- Support the design, testing, and deployment of machine learning and AI enabled use cases for approved initiatives.
- Assist in monitoring models post deployment, identifying data quality issues, bias risks, or performance drift.
Governance, Compliance & Risk Awareness
- Adhere to APWUHP Compliance requirements related to data handling and reporting requirements.
- Document data sources, logic, assumptions, and limitations to support audits, transparency, and explainability.
- Participate in responsible AI and data governance processes, ensuring ethical use of analytics across the organization.
Coordinate with IT Team Leads in conjunction with the IT Project Manager, to align with organization priorities.
Work with external vendors to develop and maintain approved solutions. Scope business functional enhancement projects and validate recommended solutions to the organization.
Complete other duties as assigned.
QUALIFICATIONS
- Bachelor’s degree in business Analytics, Data Science, Information Systems, Statistics, Computer Science, or a related discipline, or equivalent practical experience.
- 5+ years of experience in data analysis, business analysis, or analytics roles, preferably in healthcare, insurance, or other regulated environments.
- Hands‑on experience working with structured datasets and analytical tools to support business decision‑making.
- Experience collaborating with cross‑functional teams, including IT, compliance, and operations.
- Excellent technical and analytical skills, as well as exceptional verbal and written communication skills. Ability to render and write business requirements such as technical documentation and business decision documentation.
- Proficiency in requirements gathering – effectively translating business needs as expressed by users into workable specs, estimating time\duration to complete and implement the solution.
- Strong SQL and data analysis skills; experience with BI and visualization tools.
- Familiarity with machine learning or AI concepts (predictive modeling, NLP, automation), with emphasis on business application rather than model development.
- Ability to clearly communicate insights, risks, and recommendations to non‑technical audiences.
- Experience with healthcare claims, enrollment systems, or payer data preferred.
- Exposure to model governance, audit support, or regulatory reporting preferred.
- Experience supporting analytics during high volume periods such as Open Season preferred.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Note to agencies
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.