Healthcare Fraud SME

Role overview Lead complex healthcare fraud, waste, and abuse analysis focused on Medicaid investigations and related federal and state policy. You will turn claims data and investigative knowledge into practical, data-informed solutions, working with analytics specialists and presenting findings to technical teams and leaders. The role is remote and supports work connected to a federal healthcare program.

Responsibilities - Lead investigative and analytical work independently and alongside a broader team. - Analyze claims data and review applicable Medicaid laws, regulations, and policies. - Develop data-driven approaches to complex business and investigative challenges. - Work with predictive modeling teams to improve analytical methods, processes, and outcomes. - Identify useful ways to apply Medicare and Medicaid data to business questions. - Present findings clearly to technical and non-technical audiences, including leadership.

Requirements - Bachelor’s degree in a related field. - At least 15 years of relevant experience in Medicaid investigations focused on fraud, waste, and abuse. - Knowledge of healthcare fraud schemes, patterns, concepts, and investigative methods. - Familiarity with tools and data sources used to detect and analyze fraud, waste, and abuse. - Strong communication skills, including the ability to make complex findings clear and actionable. - Collaborative approach working with data scientists, clinicians, and other subject matter experts.

Benefits and work setup - Remote work, with a full-flex work week described as available where possible. - Travel is expected to be under 10%; the listed schedule is 40 hours per week. - Benefits include medical, dental, vision, retirement contributions with employer match, paid leave, holidays, and wellness offerings. - Work visa sponsorship is not provided for this role.