Medicaid & Medicare Fraud Detection SME

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee fraud detection initiatives from their inception to completion.

• Ensure that projects align with strategic goals and yield actionable outcomes to identify and prevent fraud, waste, and abuse.

• Lead teams in analyzing claims data, interpreting policies, and conducting advanced statistical evaluations.

• Mentor junior team members to foster their professional development.

• Collaborate with subject matter experts and colleagues to present findings and recommendations.

• Convey complex analytical insights to both technical and non-technical stakeholders, including leadership.

• Establish and maintain strong client relationships.

• Recognize opportunities to utilize Medicare and Medicaid data for solutions addressing fraud, waste, and abuse.

• Communicate efficiently with remote team members.

• Undertake additional responsibilities as required.

⛳️ Requirements

• Bachelor of Arts or Bachelor of Science degree.

• Minimum of 15 years of experience in Medicare and Medicaid.

• Comprehensive understanding of the U.S. healthcare system, particularly Medicare and Medicaid.

• Proficiency in analyzing healthcare claims data for the purpose of fraud detection.

• Capability to obtain and maintain a Public Trust clearance.

• NACI (T1) clearance is required.

• Travel requirement is less than 10%.

• U.S. citizenship is not a prerequisite.

🏝️ Benefits

• Options for medical plans, including those with Health Savings Accounts.

• Choices for dental plans.

• Vision plan options available.

• 401(k) plan with pre-tax and post-tax contributions, up to IRS annual limits, along with company matching.

• Flexible work weeks where feasible.

• Paid time off for vacation, sick leave, personal time, holidays, parental leave, military leave, bereavement leave, and jury duty.

• Generally, 15 days of paid leave per calendar year.

• Ten paid holidays each year.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short-term and long-term disability benefits offered.

• Life insurance coverage provided.

• Accidental death and dismemberment insurance included.

• Personal accident insurance available.

• Critical illness insurance offered.

• Business travel and accident insurance coverage.