Healthcare Fraud Data Analyst, Senior

Key Role:

Grow with our compliance and anti-fraud team with the responsibility to perform advanced analyses to ensure the integrity of the client’s health programs. Generate innovative ideas for creative solutions and collaborate with other subject matter experts to ensure specialized topics are appropriately addressed. Conduct active surveillance of notable or emerging trends in program payment structures. Assist the client in efforts to identify and assess exposure or vulnerability to fraud, waste, and abuse in programs and provide support and assistance to state program integrity functions. Assess and monitor the impact of policy and payment changes on access to care, beneficiary health outcomes, and program payments, while applying healthcare payer expertise to address payer strategic and operational priorities.

Basic Qualifications:

• 5+ years of experience using statistical methodologies to identify vulnerabilities in Medicare, Medicaid, and Managed Care programs

• Experience with health care information, such as health claims data and ICD-10 codes, physician specialty codes, survey and certification data, and provider and supplier identifiers

• Experience in statistical detection of potential healthcare fraud and abuse, using tools, such as predictive modeling, development of mathematical models, neural networks, healthcare data analytics, and data mining

• Experience in data access tools, such as SAS, SQL, Python, and R

• Experience in the design, management, and oversight of databases

• Experience with Medicare claims and pharmacy drug data

• Knowledge of Medicare Parts A, B, C, and D, and DME benefits

• Ability to obtain a security clearance

• Bachelor’s degree in a Healthcare, Science, Public Health, Policy, Statistics, Mathematics, or Economics field

Additional Qualifications:

• Experience delivering sensitive information and technical content to a wide range of stakeholders and using a variety of delivery techniques

• Experience in facilitating large meetings with both internal and external audiences

• Knowledge of the federal procurement and proposal process, and contract management principles

• Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data

• Knowledge of CMS program integrity related systems and resources

• Ability to apply automation techniques to drive insights and efficiency

• Ability to work collaboratively and build effective working relationships

• Accredited Healthcare Fraud Investigator (AHFI), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI), Certified Financial Crimes Investigator (CFCI), Certified Fraud Examiner (CFE), Certified in Healthcare Compliance (CHC), CPC, CEMA, or CPMA certifications

Clearance:

Applicants selected will be subject to a security investigation and may need to meet eligibility requirements for access to classified information.
 
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Grow With Us
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Our comprehensive benefits package includes wellness programs with HSA contributions, paid holidays, paid parental leave, a generous 401(k) match, and more. With these benefits, plus the option for flexible schedules and remote and hybrid locations, we’ll support you as you pursue a balanced, fulfilling life—at work and at home. 

Your Candidate Journey
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Compensation

At Booz Allen, we celebrate your contributions, provide you with opportunities and choices, and support your total well-being. Our offerings include health, life, disability, financial, and retirement benefits, as well as paid leave, professional development, tuition assistance, work-life programs, and dependent care. Our recognition awards program acknowledges employees for exceptional performance and superior demonstration of our values. Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible to participate in Booz Allen’s benefit programs. Individuals that do not meet the threshold are only eligible for select offerings, not inclusive of health benefits. We encourage you to learn more about our total benefits by visiting the Resource page on our Careers site and reviewing Our Employee Benefits page.

Salary at Booz Allen is determined by various factors, including but not limited to location, the individual’s particular combination of education, knowledge, skills, competencies, and experience, as well as contract-specific affordability and organizational requirements. The projected compensation range for this position is $75,600.00 to $172,000.00 (annualized USD). The estimate displayed represents the typical salary range for this position and is just one component of Booz Allen’s total compensation package for employees. This posting will close within 90 days from the Posting Date.

Work Model
Our people-first culture prioritizes the benefits of flexibility and collaboration, whether that happens in person or remotely.

• If this position is listed as remote or hybrid, you’ll periodically work from a Booz Allen or client site facility.
• If this position is listed as onsite, you’ll work with colleagues and clients in person, as needed for the specific role.

EEO Commitment

We’re an equal employment opportunity/affirmative action employer that empowers our people to fearlessly drive change – no matter their race, color, ethnicity, religion, sex (including pregnancy, childbirth, lactation, or related medical conditions), national origin, ancestry, age, marital status, sexual orientation, gender identity and expression, disability, veteran status, military or uniformed service member status, genetic information, or any other status protected by applicable federal, state, local, or international law.