Healthcare Claims Data Analyst
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Job Description
Healthcare claims data analyst developing SQL and Python fraud, waste, and abuse analytics for GDIT’s Medicare anti-fraud partnership. Remote U.S. role supporting claims investigations.
Responsibilities:
- Develop fraud, waste, and abuse analytics from concept to finished product for the Healthcare Fraud Prevention Partnership
- Work against a multi-billion-record claims warehouse assembled from public and private healthcare payers
- Translate partner and client requests into specific analytic questions
- Determine what can and cannot be answered with available data and raise limitations early
- Build analytic logic in SQL and Python against billions of claim records
- Test and refine analytics with Fraud, Waste, and Abuse Subject Matter Experts
- Distinguish genuine aberrancy from patterns explained by clinical practice, coverage policy, or claim edits
- Document methodology, assumptions, and data lineage for reproducibility
- 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 partner- and client-driven queue
- Work with Data Scientists, Business Intelligence Developers, and FWA Subject Matter Experts
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 sufficient to understand why a query is slow
- Working proficiency in Python for data analysis, producing clean and reproducible analysis code
- Ability to turn ambiguous requests into defined analytic questions
- Ability to recognize when a question cannot be answered with available data
- Experience documenting analytic work so another person can reproduce it
- Ability to learn an unfamiliar data domain quickly
- Ability to explain analytic results clearly in writing and conversation to non-analyst audiences
- Accuracy, attention to detail, and organizational discipline to manage concurrent requests
- US citizen or Permanent Resident
- Must be able to obtain/maintain Public Trust
- Work visa sponsorship will not be provided
- Candidates must reside in the United States
- Desired: healthcare claims data and coding systems experience, FWA/program/payment integrity or utilization review exposure, Snowflake/SnowSQL or comparable cloud data warehouse, Git and collaborative code review, payer coverage policy and claim edits, Tableau or other data visualization software
Benefits:
- Medical plan options, including some with Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan with pre-tax and post-tax contributions and company match
- Flexible work schedule and full flex work weeks where possible
- Paid time off, 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
- Collaborative inter-disciplinary environment
- Fully remote work arrangement
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