Investigative Analyst (CMS Healthcare Claims)

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. 

GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.

• Growth: AI-powered career tool that identifies career steps and learning opportunities
• Support: An internal mobility team focused on helping you achieve your career goals
• Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
• Flexibility: Full-flex work week to own your priorities at work and at home
• Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY
Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.