Medicaid & Medicare Fraud Detection SME
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Job Description
Medicaid and Medicare fraud detection SME leading claims analytics and FWA investigations. Supporting GDIT’s technology and mission services for CMS.
Responsibilities:
- Manage fraud detection projects from concept to completion
- Ensure projects meet strategic objectives and produce actionable results to detect and deter fraud, waste, and abuse
- Guide teams through claims data analysis, policy interpretation, and advanced statistical analysis
- Nurture junior-level team members
- Partner with subject matter experts and team members to deliver findings and recommendations
- Present complex analytics and insights to technical and non-technical audiences and leadership
- Build and maintain client relationships
- Identify opportunities to leverage Medicare and Medicaid data for fraud, waste, and abuse solutions
- Communicate effectively with remote team members
- Perform additional duties as assigned
Requirements:
- Bachelor of Arts/Bachelor of Science
- At least 15 years of experience in Medicare/Medicaid
- Deep knowledge of the U.S. healthcare system, including Medicare and Medicaid
- Expertise in analyzing healthcare claims data for fraud detection
- Ability to obtain/maintain a Public Trust
- NACI (T1) required
- Less than 10% travel
- US citizenship is not required
Benefits:
- Medical plan options, including options with Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan with pre-tax and post-tax contributions up to IRS annual limits and company match
- Full flex work weeks where possible
- Paid vacation, sick, personal time, holidays, 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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