Medicaid & Medicare Fraud Detection SME

General Dynamics
United States
Workplace: RemoteFull timeUSD 148,750 - 201,250 annuallyFunction: Data Science & Machine LearningExperience: 15+ yearsEducation: bachelorsSkills: ["Collaboration","Deliverables management","Communication"]

Lead fraud detection efforts for Medicare and Medicaid, guiding teams through complex analyses and tool development to detect and deter fraud, waste, and abuse. Manage projects from concept to completion, mentor junior analysts, and translate healthcare claims data and policy interpretation into actionable recommendations. Partner with subject matter experts, build client relationships, and clearly present complex analytics to both technical and non-technical leadership while working remotely.

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FursaFursa
General Dynamics
General Dynamics
6 days ago

Medicaid & Medicare Fraud Detection SME

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Last checked: 5 hours agoStatus: Live

Job Summary

Lead fraud detection efforts for Medicare and Medicaid, guiding teams through complex analyses and tool development to detect and deter fraud, waste, and abuse. Manage projects from concept to completion, mentor junior analysts, and translate healthcare claims data and policy interpretation into actionable recommendations. Partner with subject matter experts, build client relationships, and clearly present complex analytics to both technical and non-technical leadership while working remotely.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Data Science & Machine Learning
Seniority: Mid level

Key Responsibilities

  • •Lead teams through complex analyses and tool development to detect and prevent fraud, waste, and abuse in Medicare programs.
  • •Manage fraud detection projects from concept to completion, ensuring alignment to strategic objectives and actionable results.
  • •Guide teams in completing tasks, including mentoring junior members on claims data analysis and policy interpretation.
  • •Partner with subject matter experts to deliver quality findings and actionable recommendations.
  • •Present complex analytics and insights to technical and non-technical audiences and leadership while working remotely.
Travel: Low travel

Pay and Benefits

Salary: USD 148,750 - 201,250 annually
Perks:Health InsuranceDentalVision401kPaid Parental

Key Requirements

  • •Bachelor of Arts/Bachelor of Science and at least 15 years of experience in Medicare/Medicaid.
  • •Deep knowledge of the U.S. healthcare system with expertise analyzing healthcare claims data for fraud detection.
  • •Ability to manage fraud detection projects from concept to completion aligned to strategic objectives.
  • •Experience guiding junior team members through claims data analysis, policy interpretation, and advanced statistical analysis.
  • •Ability to obtain/maintain a Public Trust (NACI (T1)).
Experience:15+ yearsHealthcareFraud detectionMedicare/Medicaid
Education:Bachelor's
Skills:CollaborationDeliverables managementCommunication

Eligibility

Security Clearance:NACI (T1)

Company Brief

General Dynamics
Provides IT, systems engineering, cybersecurity, cloud, and mission support services to U.S. federal civilian and defense agencies, delivering large-scale technology solutions and managed services for national security and government operations.
Industry: Defense Technology
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Headquarters: Tysons / Fairfax, United States
WebsiteLinkedIn