Investigative Analyst (CMS Healthcare Claims)

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Health Insurance Claims, Investigation, Medical Claims Analysis

Certifications:

None

Experience:

8 + years of related experience

US Citizenship Required:

No

Job Description:

GDIT is hiring a healthcare claims Investigative Analyst to support the Centers for Medicare and Medicaid (CMS), you will be trusted to identify trends in the data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members (Partner) and the Trusted Third Party (TTP).

You will be part of a 50-person team supporting the TTP which was established in 2012 to reduce fraud, waste and abuse in healthcare data.

This position is remote

Work visa sponsorship will not be provided

WHAT YOU'LL BE DOING:

• Performs analytical tasks in support of 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
• Develops 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
• Interacts regularly with Partners regarding referrals and leads identified
• May 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

WHAT YOU'LL NEED TO SUCCEED (required):

• BA/BS or equivalent experience
• 8+ years’ experience in health care 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.

WHAT WOULD BE EVEN BETTER (preferred):

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

SKILLS & ATTRIBUTES FOR SUCCESS:

• Strong decision-making skills and a demonstrated history of established leadership qualities as well as proven organizational skills. 
• Commitment to confidentiality, privacy, and professionalism.
• Ability to independently follow through on problems. 
• Detail oriented and ability to prioritize multiple tasks and work under pressure. 
• Ability to work on complex projects with general direction and minimal guidance 
• Ability to build effective relationships, demonstrating strong interpersonal skills.
• Exhibit high initiative to get things accomplished; high organizational ability to juggle multiple priorities.
• Ability to perform well and achieve goals both in a team environment, with staff at all levels, and independently. 

The likely salary range for this position is $77,775 - $105,225. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

 

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.