Healthcare Claims Data Analyst
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Job Description
Healthcare claims analyst developing SQL and Python fraud, waste and abuse analytics for GDIT’s CMS anti-fraud programs. Identifying aberrant billing across billions of payer claims.
Responsibilities:
- Support Centers for Medicare and Medicaid Services anti-fraud activities
- Develop fraud, waste and abuse analytics from concept to finished product at the Trusted Third Party
- Work against a multi-billion-record claims warehouse assembled from public and private healthcare payers
- Translate Partner and client requests into specifiable analytic questions
- Determine what can and cannot be answered with available data and raise limitations early
- Develop FWA analytics end to end using SQL and Python against billions of claim records
- Test and refine analytics with FWA Subject Matter Experts
- Separate genuine aberrancy from patterns explained by legitimate clinical practice, coverage policy or claim edits
- Document methodology, assumptions and data lineage for reproducibility and incorporation into the analytic suite
- Document findings and present results to internal stakeholders
- Participate in Partner discussions to clarify analytic requirements
- Manage several concurrent requests against firm deadlines in a queue driven by Partner and client demand
- Work with Data Scientists, Business Intelligence Developers and FWA Subject Matter Experts on a fully remote multidisciplinary team
Requirements:
- Bachelor's degree in a quantitative or health-related field, or equivalent hands-on experience
- 4+ years writing SQL against large relational data, including CTEs, window functions and multi-table joins at scale
- Performance awareness to understand why a query is slow
- Working proficiency in Python for data analysis, producing clean and reproducible analysis code
- Ability to turn an ambiguous request into a defined analytic question
- Experience documenting analytic work so another person can reproduce it
- Ability to come up to speed quickly in an unfamiliar data domain
- Ability to explain analytic results clearly to non-analyst audiences
- Accuracy, attention to detail and organizational discipline
- US citizen or Permanent Resident
- Must be able to obtain/maintain Public Trust
- Work visa sponsorship will not be provided
- Desired: experience with healthcare claims data and coding systems such as ICD-10, CPT, HCPCS, and DRG
- Desired: exposure to fraud, waste and abuse, program integrity, payment integrity or utilization review
- Desired: experience with Snowflake and SnowSQL or comparable cloud data warehouse
- Desired: Git and collaborative code review practices
- Desired: familiarity with payer coverage policy and claim edits such as NCCI
- Desired: Tableau or other data visualization software
Benefits:
- Competitive pay and benefits
- Flexible work schedule
- Medical plan options, some with Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan with pre-tax and post-tax contributions and company match
- Full flex work weeks where possible
- Paid time off plans including vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave
- Typically 15 days of paid leave per calendar year
- 10 paid holidays per year
- Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees
- Short- and long-term disability benefits
- Life insurance
- Accidental death and dismemberment insurance
- Personal accident insurance
- Critical illness insurance
- Business travel and accident insurance
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