Healthcare Claims Data Analyst

At GDIT, people are our differentiator. Our work depends on a Data Analyst joining our team to support Centers for Medicare and Medicaid Services anti-fraud activities. As a Data Analyst supporting the Healthcare Fraud Prevention Partnership (HFPP), you will develop fraud, waste and abuse (FWA) analytics from concept to finished product at the Trusted Third Party (TTP), working against a multi-billion record claims warehouse assembled from dozens of public and private healthcare payers. HFPP Partners and the client bring the questions; you turn them into analytics that identify aberrant billing and hold up to scrutiny. This is a remote role; candidates must reside in the United States.

Responsibilities

• Work with a multi-disciplinary team of Data Scientists, Business Intelligence Developers, and FWA Subject Matter Experts on a 100% remote, distributed team.
• Translate Partner and client requests into specifiable analytic questions, including determining what can and cannot be answered with the available data and raising limitations early.
• Develop FWA analytics end-to-end: build analytic logic in SQL and Python against billions of claim records, test it, and refine it in collaboration with FWA Subject Matter Experts until it identifies genuine aberrancy.
• Distinguish genuine fraud, waste, and abuse from patterns explained by legitimate clinical practice, coverage policy, or claim edits, ensuring mundane explanations are identified before Partners.
• Document methodology, assumptions, and data lineage so analytics can be reproduced and incorporated into the TTP analytic suite by other teams without the original analyst present.
• Document findings and present results to internal stakeholders; participate in Partner discussions to clarify analytic requirements.
• Manage several concurrent requests against firm deadlines within a queue driven by Partner and client demand.

Requirements

• Bachelor's degree in a quantitative or health-related field, or equivalent hands-on experience.
• 4+ years of experience writing SQL against large relational data, including CTEs, window functions, and multi-table joins at scale, with performance awareness.
• Working proficiency in Python for data analysis, producing clean and reproducible analysis code (pandas or equivalent).
• Demonstrated ability to turn ambiguous requests into defined analytic questions, including recognizing when a question cannot be answered with the available data.
• Experience documenting analytic work so another person can reproduce it; evidence of quickly coming up to speed in an unfamiliar data domain.
• Ability to explain analytic results clearly, in writing and conversation, to non-analyst audiences.
• Accuracy, attention to detail, and organizational discipline to manage several concurrent requests without dropping any.
• US citizen or Permanent Resident.
• Must be able to obtain and maintain Public Trust clearance.

Desired Qualifications

• Experience with healthcare claims data (Medicare, Medicaid, or commercial) and healthcare coding systems (e.g., ICD-10, CPT, HCPCS, DRG).
• Exposure to fraud, waste, and abuse, program integrity, payment integrity, or utilization review work.
• Experience with Snowflake and SnowSQL, or a comparable cloud data warehouse.
• Version control (Git) and collaborative code review practices.
• Familiarity with payer coverage policy (LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI).
• Experience using Tableau or other data visualization software.

Benefits

• Competitive pay and benefits, flexible work schedule, and a collaborative interdisciplinary environment where the best idea wins.
• Medical plan options, some with Health Savings Accounts, dental and vision plans.
• 401(k) plan with pre- and post-tax contribution options and company match.
• Paid time off: 15 days of vacation, sick, and personal time per calendar year (prorated based on hire date), plus 10 paid holidays.
• GDIT Paid Family Leave program: up to 160 hours of paid leave in a rolling 12-month period for eligible employees.
• Short- and long-term disability benefits, life insurance, accidental death and dismemberment, personal accident, critical illness, and business travel and accident insurance.

Pay

The likely salary range for this position is $76,500 - $103,500. Salary will be set based on experience, geographic location, and possibly contractual requirements and could fall outside of this range.

Schedule

• Scheduled weekly hours: 40
• Travel required: Less than 10%
• Telecommuting options: Remote (candidates must reside in the United States)