Investigative Analyst (CMS Healthcare Claims)

Responsibilities

• Perform analytical tasks to identify fraud, waste, and abuse referrals and leads
• Conduct data mining across the partnership using internal tools
• Collaborate on the development of HFPP analytic reports
• Develop fraud, waste, and abuse referrals and leads for Partners
• Drive outcome metrics related to fraud, waste, and abuse referrals and leads
• Interact regularly with Partners regarding identified referrals and leads
• May perform business development activities including analyzing health claims data and developing provider profiles

Requirements

• BA/BS or equivalent experience
• 8+ years of experience in healthcare claims analysis
• Strong oral and written communication skills
• Expert level knowledge of Microsoft Office suite
• Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence
• Working knowledge of HIPAA privacy and security rules

Preferred Qualifications

• Certified Fraud Examiner (CFE) designation
• Accredited Healthcare Fraud Investigator (AHFI) designation
• Certified clinical coding

About the Company

GDIT is 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.