Investigative Analyst (CMS Healthcare Claims)

GDIT is hiring a healthcare claims Investigative Analyst to support the Centers for Medicare and Medicaid (CMS). You will identify trends in data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members and the Trusted Third Party (TTP). This remote position is part of a 50-person team established in 2012 to reduce fraud, waste, and abuse in healthcare data. Work visa sponsorship is not provided.

Responsibilities

• Perform analytical tasks in support of the HFPP program, including identifying fraud, waste, and abuse referrals and leads from HFPP Analytics.
• Conduct data mining across the partnership utilizing internal tools.
• Collaborate on the development of HFPP analytic reports.
• Develop fraud, waste, and abuse referrals and leads for Partners based on HFPP analytic reports.
• Drive outcome metrics related to fraud, waste, and abuse referrals and leads shared with Partners.
• Interact regularly with Partners regarding referrals and leads identified.
• Perform business development activities including analyzing health claims data, generating study referrals and leads, developing provider background profiles, and identifying opportunities for Partner collaboration meetings.

Requirements

• BA/BS or equivalent experience.
• 8+ years’ experience in healthcare claims analysis (equivalent work experience will be considered in lieu of degree).
• Strong oral and written communication skills with the ability to present to management-level staff.
• Expert-level knowledge of Microsoft Office suite.
• Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence.
• Working knowledge of HIPAA privacy and security rules.

Preferred Qualifications

• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired.
• Certified clinical coding.

Skills & Attributes

• Strong decision-making skills and a demonstrated history of established leadership qualities.
• Proven organizational skills and commitment to confidentiality, privacy, and professionalism.
• Ability to independently follow through on problems.
• Detail-oriented with the ability to prioritize multiple tasks and work under pressure.
• Ability to work on complex projects with general direction and minimal guidance.
• Strong interpersonal skills and ability to build effective relationships.
• High initiative to accomplish tasks and organizational ability to juggle multiple priorities.
• Ability to perform well and achieve goals both in a team environment and independently.

Benefits

• Comprehensive medical, dental, and vision plan options, some with Health Savings Accounts.
• 401(k) plan with company match (pre- and post-tax contributions up to IRS annual limits).
• Full-flex work week to support work/life balance.
• Paid time off including vacation (15 days/year), sick and personal time, and 10 paid holidays (prorated based on hire date).
• Paid Family Leave program providing up to 160 hours of paid leave in a rolling 12-month period.
• Short- and long-term disability benefits, life insurance, accidental death and dismemberment, personal accident, critical illness, and business travel and accident insurance.
• AI-powered career tool for growth opportunities.
• Internal mobility team focused on career development.
• Award-winning culture of innovation and military-friendly workplace.

Pay

The likely salary range for this position is $83,927 - $113,549. Salary will be set based on experience, geographic location, and possibly contractual requirements.

Schedule

• Scheduled weekly hours: 40
• Travel required: Less than 10%
• Telecommuting options: Remote (any location in the US)