Softrams is hiring a
Healthcare Fraud Data Analyst

Summary

Softrams is seeking a Healthcare Data Analyst to research program integrity vulnerabilities and develop analytical models for fraud prevention efforts. The role requires 8+ years of experience in data analysis, software/application development, business system analysis, or program integrity investigations. The candidate must have a Bachelor’s degree in a quantitative field, knowledge of healthcare claims data, advanced proficiency with analytical software, and experience using cloud-based services.

Requirements

• Bachelor’s degree in data science, statistics, mathematics, public health, economics, or related quantitative field
• 8+ years' experience in data analysis, software/application development, business system analysis, or program integrity investigations
• 5+ years of experience using statistical methodologies to assess healthcare program integrity, or evaluate healthcare outcomes, access to care, equity and other research especially in Medicare, Medicaid, and Managed Care programs
• Knowledge of healthcare claims data and beneficiary benefits, especially in Medicare and Medicaid
• Advanced proficiency with analytical software including Python and/or R
• In-depth knowledge of statistics and algorithms used in machine learning, text analytics, deep learning, and/or predictive modeling their appropriate use
• Experience with data engineering using SQL queries, Spark, and/or python to extract and transform large volumes of data into a format suitable for analysis
• Experience using cloud-based services and resources (e.g., AWS, Azure, Google cloud)
• Ability to obtain a Public Trust Clearance

Responsibilities

• Work with business owners, product managers and other stakeholders to develop and refine analytic solutions to address healthcare program integrity challenges and/or healthcare outcomes
• Assist the team and client to identify and evaluate vulnerabilities in identity theft, improper payments, and quality of care in healthcare programs
• Assess and monitor healthcare system transactions and claims and other data for anomalies in healthcare provider and submitter behaviors
• Conduct research and development using healthcare to design and develop data science and statistical models
• Run tests, perform evaluative statistical analysis, and interpret test results, and work with subject matter experts to evaluate the effectiveness of models
• Work with the teams to ensure that algorithms generate accurate and interpretable reports and user recommendations
• Develop and deploy automated analytical applications that handle large datasets and/or real-time data and automated processes to monitor and report on model performance and take responsibility for corrective actions
• Prepare complete and accurate documentation of machine learning processes
• Present and vet developed models to stakeholders collect feedback for improvement and provide information on their use

Preferred Qualifications

• Strong problem-solving skills with an emphasis on analytical product development in a business context, particularly with government-related data
• Excellent attention to detail and ability to maintain quality control for one’s own work or the work of others
• Excellent written and verbal communication skills for coordinating across teams and interacting with clients
• Ability to manage multiple projects efficiently and able to meet deadlines with time management and organizational skills
• Knowledge of working in a team-based agile work environment with certification in the Scaled Agile Framework (SAFe) or the capacity to obtain certification
• Excellent communication skills and an effective technical writer with the ability to communicate complex data in a simple, actionable way

Benefits

Recognized as a Top Workplace USA (2024), Top Workplaces in Technology (2023, 2021), INC 5000, Fastest growing companies in America (2023, 2022), Washington Business Journal Top 75 Fastest Growing Companies in Greater Washington area, 2020 NXT UP - Top Federal Emerging Technology and consulting firms, 2020 Inaugural DC Metro’s Most Successful Companies, 2020 Washington Technology Fast 50, NVTC Tech 100 (2020, 2019)