Medicaid & Medicare Fraud Detection SME

About this role

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: NACI (T1) Job Family: Functional Experts Job Qualifications: Skills: Collaboration, Deliverables Management, Fraud Detection, Fraud Investigations Certifications: None Experience: 10 + years of related experience US Citizenship Required: No 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 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. 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 inte

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