Senior Analyst, Payment Integrity Analytics

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

📋 Description

• Utilize established FWA analytical models on Medicaid claims data to detect potential fraud, waste, and abuse.

• Provide monthly, prequalified FWA lead referral reports consistently and reliably.

• Generate reports that effectively communicate the analytical rationale, suspected behavior, and investigative significance of each lead.

• Ensure that all outputs are defensible, audit-ready, and tailored for non-technical investigative and policy audiences.

• Present FWA lead referrals to state Medicaid program integrity and OIG personnel.

• Clarify findings, methodologies, and data sources to support state investigations.

• Address follow-up inquiries and conduct supplemental or ad hoc analyses related to specific referrals.

• Assist investigations through documentation, exhibits, and data interpretation.

• Engage in meetings and briefings, and provide testimony or in-person investigative support as needed (travel may be necessary).

⛳️ Requirements

• Significant experience in analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse (5+ years).

• Comprehensive understanding of Medicaid program integrity, including prevalent FWA schemes, audit methodologies, and investigative processes (5+ years).

• Ability to prepare reports and presentations that document analytical methods and results for both internal and external stakeholders (4+ years).

• Experience in reading, interpreting, and applying Medicaid policy, regulations, state plan language, and related guidance.

• Excellent written and verbal communication skills, with a background in presenting analytic findings to state agencies, Offices of Inspector General, or other oversight bodies.

• Previous experience working directly with state Medicaid agencies and/or Offices of Inspector General is strongly preferred.

• Professional certifications such as Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), and/or Accredited Health Care Fraud Investigator (AHFI) are preferred.

🏝️ Benefits

• Generous, flexible vacation policy

• Educational assistance

• Comprehensive health benefits

• 401(k) employer match

• Leadership and technical development academies