Healthcare Fraud SME

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

NACI (T1)

Job Family:

Functional Experts

Job Qualifications:

Skills:

Fraud Analytics, Leadership, Medicaid, Medicare, Work Collaboratively

Certifications:

None

Experience:

15 + years of related experience

US Citizenship Required:

No

Job Description:

Make meaningful contributions that fuel critical outcomes for some of the most complex government, defense, and intelligence projects. Join GDIT as a Healthcare Fraud, Waste and Abuse (FWA) Subject Matter Expert (SME) for a career where your growth is just as important as the mission you support.

As a Healthcare FWA SME, the work you’ll do at GDIT will be impactful to the mission of the Centers for Medicare & Medicaid Services (CMS).

***Work visa sponsorship will not be provided for this role.

HOW A HEALTHCARE FRAUD SME WILL MAKE AN IMPACT:

• Leading efforts of technical tasks to completion independently and as part of a team.
• Leading efforts to analyze claims data and reviews Federal and State Medicaid law, regulation, and policy.
• Developing data-driven solutions to business challenges of advanced scope/complexity.
• Collaborating with predictive modeling teams to increase and optimize customer experiences, efficiencies, process improvements, and other business outcomes.
• Identifying opportunities for leveraging Medicare and Medicaid data to drive insightful business solutions.
• Presenting findings to a range of audiences (technical/non-technical) and to various levels of leadership.
• Effectively communicating with team members while working remotely

WHAT YOU'LL NEED TO SUCCEED:

• Bachelor’s degree (BA/BS) in a related field.
• Minimum of 15 years of relevant experience in Medicaid investigative roles focused on fraud, waste, and abuse.
• Familiarity with investigative tools, data sources, and methodologies commonly used in FWA detection and analysis.
• Knowledge of healthcare FWA concepts, schemes, trends, and investigative approaches.
• Ability to communicate complex fraud-related findings in a clear, concise way that enables quick action.
• Team-oriented outlook to facilitate collaboration across a cross-functional team of data scientists, clinicians, and other FWA SMEs.

GDIT IS YOUR PLACE:

• At GDIT, the mission is our purpose, and our people are at the center of everything we do.
• Growth: AI-powered career tool that identifies career steps and learning opportunities.
• Support: An internal mobility team focused on helping you achieve your career goals.
• Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off.
• Flexibility: Full-flex work week to own your priorities at work and at home.
• Community: Award-winning culture of innovation and a military-friendly workplace.

OWN YOUR OPPORTUNITY:

Explore a career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your ambition to deliver your best work.

The likely salary range for this position is $153,000 - $207,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.
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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans