Healthcare Fraud Data Analyst

Federal Requirements:  

• Ability to obtain a U.S. Federal Position of Trust clearance designation.  
• Must reside in and be able to perform work in the United States.  
• Must have lived in the United States for 3 of the last 5 years.  

Required Qualifications:

• Bachelor’s degree in data science, statistics, mathematics, public health, economics, or related quantitative field, 
• 8+ years' experience in data analysis, software/application development, business system analysis, or program integrity investigations. 
• 5+ years of experience using statistical methodologies to assess healthcare program integrity, or evaluate healthcare outcomes, access to care, equity and other research especially in Medicare, Medicaid, and Managed Care programs. 
• Knowledge of healthcare claims data and beneficiary benefits, especially in Medicare and Medicaid. 
• Advanced proficiency with analytical software including Python and/or R, to manipulate and analyze data and to build analytical models. 
• In-depth knowledge of statistics and algorithms used in machine learning, text analytics, deep learning, and/or predictive modeling their appropriate use. 
• Experience with data engineering using SQL queries, Spark, and/or python and to extract and transform large volumes of data into a format suitable for analysis. 
• Experience using cloud-based services and resources (e.g., AWS, Azure, Google cloud).. 
• Ability to obtain a Public Trust Clearance.  This role may require the hired candidate to go through public clearance. A minimum of 3 years of stay in the U.S. within the last 5 years is a must to be eligible to qualify for public trust clearance sponsorship. 

Preferred Qualifications:

• Strong problem-solving skills with an emphasis on analytical product development in a business context, particularly with government-related data. 
• Excellent attention to detail and ability to maintain quality control for one’s own work or the work of others. 
• Excellent written and verbal communication skills for coordinating across teams and interacting with clients. 
• Ability to manage multiple projects efficiently and able to meet deadlines with time management and organizational skills. 
• Knowledge of working in a team-based agile work environment with certification in the Scaled Agile Framework (SAFe) or the capacity to obtain certification. 
• Excellent communication skills and an effective technical writer with the ability to communicate complex data in a simple, actionable way. 

Responsibilities:

• Work with business owners, product managers and other stakeholders to develop and refine analytic solutions to address healthcare program integrity challenges and/or healthcare outcomes. 
• Assist the team and client to identify and evaluate vulnerabilities in identity theft, improper payments, and quality of care in healthcare programs.  
• Assess and monitor healthcare system transactions and claims and other data for anomalies in healthcare provider and submitter behaviors.  
• Conduct research and development using healthcare to design and develop data science and statistical models. 
• Run tests, perform evaluative statistical analysis, and interpret test results, and work with subject matter experts to evaluate the effectiveness of models.  
• Work with the teams to ensure that algorithms generate accurate and interpretable reports and user recommendations. 
• Develop and deploy automated analytical applications that handle large datasets and/or real-time data and automated processes to monitor and report on model performance and take responsibility for corrective actions.  
• Prepare complete and accurate documentation of machine learning processes. 
• Present and vet developed models to stakeholders collect feedback for improvement and provide information on their use.