Sr. Research Analyst, Program Integrity (FWA)

Research & Focus Studies

Identify and frame FWA focus studies and use cases aligned to CMS/HHS priorities; draft clear, testable analysis plans with defined methods, data sources, and success criteria.

Conduct environmental scans and literature reviews on FWA and other assigned topics, and produce evidence-based reports and narratives tailored for CMS, client, and federal audiences.

Hands-On Analysis & Technical Execution

Build and run analyses in SQL, Python, and Databricks — from data profiling through final results — and shepherd them to defensible completion that withstands client, clinical, and audit scrutiny.

Ensure data validity and integrity; translate large healthcare datasets into clear dashboards, visualizations, and executive summaries.

Apply FWA domain expertise throughout, encoding pattern recognition for schemes and billing anomalies into analytic logic.

Guide and coordinate with other data team members and stakeholders to identify appropriate data sources and methodologies consistent with best practices in FWA research, frame analytic questions, and draft clear written findings (briefs, summaries) and deliver verbal updates to stakeholders, including non-technical and federal audiences.

Program Evaluation & Impact

Design and execute mixed-methods evaluations; develop and interpret integrity and quality indicators (e.g., improper payments, aberrant billing, appeals, timeliness, disparities).

Build evaluation frameworks and logic models measuring performance, outcomes, and ROI; surface and communicate opportunities for improvement.

Growth & Stakeholder Engagement

Support growth and business development initiatives and proposals where program integrity is the differentiator — secondary to, and never crowding out, the core research mandate.

Map work to broader CMS/HHS initiatives and partner agencies (AHRQ, CDC, NIH); collaborate with policy and communications teams on research messaging.

Qualifications

• Bachelor’s degree in Health Policy, Public Health, Healthcare Administration, Statistics, Data Science, Economics, or a related health or quantitative field required.
• Expert-level FWA / program-integrity domain knowledge — minimum of 8 years of substantial experience in healthcare FWA (payer SIU, program-integrity contracting, CMS/Medicaid integrity, or equivalent), sufficient to serve as the team’s domain authority.
• Hands-on technical ability — strong SQL skills and working proficiency in Python; able to independently query, profile, and analyze large healthcare datasets.
• Applied research skill — designing analysis plans and carrying qualitative and quantitative analyses to defensible conclusions.
• Proven leadership as a subject-matter expert — a track record of leading project teams or analytic workstreams, now oriented toward hands-on delivery in this role.
• Healthcare systems & policy fluency — CMS frameworks, Medicare/Medicaid programs, regulatory structures, and data governance.
• Clear communication — synthesize and present findings to varied audiences (including clients and policymakers).

Preferred Requirements

• Databricks / Spark experience, or a track record of ramping quickly on new tooling.
• Advanced degree (Master’s or PhD in a health or quantitative field); equivalent FWA experience also considered.
• Data visualization & standards — QuickSight, Qlik, Power BI, or Tableau; familiarity with claims data and coding systems (ICD, CPT/HCPCS, NPI).
• Ways of working — Agile / cross-functional experience; prior healthcare proposal contribution.