Healthcare Fraud Research Analyst, Senior

Healthcare Fraud Research Analyst, Senior

Key Role:

Grow with our compliance and anti-fraud team with the responsibility to perform advanced analyses to ensure the integrity of health insurance programs. Assist with developing and implementing the program's integrity-focused engagement and growth strategy. Leverage client-specific knowledge and networks to lead, plan, grow, and manage progressively larger and more complex 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 CMS program payment structures. Assist the client in efforts to identify and assess exposure or vulnerability to fraud, waste, and abuse in CMS 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 CMS program payments, while applying healthcare payer expertise to address payer strategic and operational priorities. Due to the nature of work performed within this facility, U.S. citizenship is required.

Basic Qualifications:

• Experience in the design, management, and oversight of research and development projects
• Experience with analyzing, interpreting, and writing a report of data findings to identify vulnerabilities for fraud, waste, and abuse in health insurance programs
• Experience with health insurance claims and pharmacy drug data
• Knowledge of basic epidemiologic and statistical concepts
• Knowledge of Medicare Parts A, B, C, DME, and D benefits
• Bachelor's degree

Additional Qualifications:

• Experience with delivering sensitive information and technical content to a wide range of stakeholders and using a variety of delivery techniques
• Knowledge of CMS claims data 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
• Knowledge of the federal procurement and proposal process, and contract management principles
• 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), and Certified in Healthcare Compliance (CHC) Certifications
• Medical Auditing or Clinical Coding Certifications such as CPC, CEMA, or CPMA Certifications

Create Your Career:

Grow With Us

Your growth matters to us—that’s why we offer a variety of ways for you to develop your career. With professional and leadership development opportunities like upskilling programs, tuition reimbursement, mentoring, and firm-sponsored networking, you can chart a unique and fulfilling career path on your own terms.

A Place Where You Belong

Diverse perspectives cultivate collective ingenuity. Booz Allen’s culture of respect, equity, and opportunity means that, here, you are free to bring your whole self to work. With an array of business resource groups and other opportunities for connection, you’ll build your community in no time.

Support Your Well-Being

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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