Medicaid & Medicare Fraud Detection SME

Clearance Level
None
Category
Functional Experts
Location
Remote, Working from the USA
Key Skills For Success

Collaboration

Deliverables Management

Fraud Detection

Fraud Investigations

REQ#: RQ227275
Public Trust: NACI (T1)
Requisition Type: Regular
Your Impact

Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.

Job Description

As a Functional Analyist SME the work you’ll do at GDIT will be impactful to the mission of the Centers for Medicare and Medicaid Services (CMS). You will play a crucial role in leading teams through complex analyses and tool development to detect and prevent fraud, waste, and abuse (FWA) in the Medicare programs.

  • Manage fraud detection projects from concept to completion, ensuring they meet strategic objectives and include actionable results to detect and deter FWA

  • Guide teams in the completion of tasks including nurturing junior level team members through claims data analysis, interpretation of policy, and conducting of advanced statistical analysis

  • Partner with subject matter experts and other team members to deliver quality findings and actionable recommendations

  • Present complex analytics and insights in a comprehensible manner to a range of audiences (technical/non-technical) and to various levels of leadership

  • Build and maintain client relationships

  • Identify opportunities for leveraging Medicare and Medicaid data to drive insightful FWA solutions

  • Effectively communicate with team members while working remotely

  • Perform additional duties as assigned


Required Skills:

  • Bachelor of Arts/Bachelor of Science and at least 15 years of experience in Medicare/Medicaid

  • Deep knowledge of U.S. healthcare system including Medicare and Medicaid with an expertise in analyzing healthcare claims data for the use of fraud detection

  • Ability to obtain/maintain a Public Trust

Work Requirements

Years of Experience

10 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%

Salary and Benefit Information

The likely salary range for this position is $148,750 - $201,250. 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.
View information about benefits and our total rewards program.

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.

About Our Work

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

Join our Talent Community to stay up to date on our career opportunities and events at gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans