Senior Manager, Federal Healthcare Program Integrity & Advanced Analytics

Analytica is seeking a Senior Manager Federal Healthcare Program Integrity & Advanced Analytics to lead the development and delivery of data-driven solutions that help federal healthcare organizations prevent detect investigate and mitigate fraud waste abuse improper payments and other program-integrity vulnerabilities.

This senior client-facing position sits at the intersection of healthcare program integrity fraud analytics advanced analytics and AI investigative support and federal health growth. The successful candidate will work with program-integrity leaders investigators analysts clinicians auditors policy experts data scientists and technology teams to translate complex healthcare fraud and integrity challenges into defensible analytical strategies risk indicators investigative leads and measurable mitigation approaches.

The ideal candidate understands how healthcare claims encounters enrollment provider beneficiary payment pharmacy managed-care and investigative data can be used to identify suspicious behavior assess vulnerabilities support investigations improve oversight and protect federal healthcare programs.

This individual will serve as a senior subject-matter leader supporting Analyticas work and growth across the Centers for Medicare & Medicaid Services the Defense Health Agency the Department of Veterans Affairs and adjacent federal healthcare organizations.

The position requires more than technical data-science expertise. The successful candidate must understand the operational realities of healthcare program integrity and be able to help clients move from data and analytical findings to prioritized action. The individual will also contribute customer insight professional relationships technical leadership and solution concepts to Analyticas capture and proposal efforts.

Required Qualifications:

• Masters degree or doctorate in a relevant quantitative healthcare economics public policy informatics or technology discipline.
• Direct experience supporting federal healthcare program integrity fraud prevention investigation payment integrity oversight or enforcement particularly CMS DHA/Military Health System/TRICARE HHS OIG DOJ healthcare fraud initiatives or state Medicaid program integrity
• Deep experience with one or more federal healthcare domains including Medicaid Medicaid managed care Medicare Fee-for-Service Medicare Advantage Part D TRICARE provider enrollment pharmacy or healthcare claims.
• Experience supporting healthcare fraud investigations or developing fraud indicators risk scores anomaly/outlier methods entity resolution network analysis provider profiles or investigative lead-generation models.
• Experience evaluating program-integrity interventions and translating analytical findings into actionable investigative payment-integrity or program decisions.
• Experience with modern analytics environments and technologies such as Python SAS R SQL Databricks Snowflake cloud data platforms ML/AI platforms or graph technologies.
• Experience applying NLP LLMs RAG OCR semantic analysis entity resolution network/link analysis or other AI techniques to complex healthcare or investigative information
• Familiarity with responsible AI model validation and explainability privacy security and federal healthcare data governance.
• Experience contributing to federal solution development capture proposals client engagement or growth activities.
• Established professional network within the federal healthcare program-integrity investigative analytics or government-contractor community.
• Excellent written verbal presentation and facilitation skills.
• Ability to obtain and maintain the federal suitability Public Trust or other clearance required for assigned work.

Preferred Qualifications:

• Recognized healthcare/program-integrity thought leadership through client leadership publications presentations professional associations government working groups or industry forums

AboutANALYTICA:Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health civilian and national security missions. Founded in 2009 and headquartered in Bethesda MD the company is an establishedSBAsmall businessthat hasbeen recognized byInc. Magazineeach of the past three years as one of the 250 fastest-growingcompanies in theU.S. Analytica specializes in providing software and systems engineering information management analytics & visualization agile project management and management consulting companyis appraised by theSoftware Engineering Institute (SEI) atCMMI Maturity Level 3and is anISO 9001:2008 certifiedprovider.

Analytica LLC is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all individuals regardless of race color religion sex sexual orientation gender identity national origin age disability or any other characteristic protected by applicable federal state or local law. As a federal contractor we comply with the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA) and take affirmative action to employ and advance in employment qualified protected veterans. We ensure that all employment decisions are based on merit qualifications and business needs. We prohibit discrimination and harassment of any kind. Analytica LLC also provides reasonable accommodations to applicants and employees with disabilities in accordance with applicable law.

To enhance efficiency fairness and accuracy Analytica may use AI-assisted tools to support certain aspects of our hiring process.

• Application Review: AI tools may help identify skills and experiences relevant to the role.
• Interview Support: AI-powered notetaking tools may be used during interviews to document discussions and summarize key points.

These tools are used to assist our team. All hiring decisions are made by Analytica recruiters and hiring managers.

By submitting an application you acknowledge that AI-assisted tools may be used to support parts of the application and interview process.

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