Healthcare Intelligence Analyst / Investigator

at General Dynamics Information Technology in Dover, Delaware, United States

Job Description

Type of Requisition: Regular

Clearance Level Must Be Able to Obtain: None

Public Trust/Other Required: None

Job Family: Intelligence

The Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance Marketplace?) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), CMS has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance Agents and Brokers, and others who assist with FFM enrollments. The Marketplace Program Integrity Contractor (MPIC) supports this oversight. Through research, investigation, and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative action to CMS; and recommend referral to law enforcement if it identifies potential fraud, waste, and abuse (FWA).

Job Description

This is a job opportunity for an Intelligence Analyst to support MPIC investigative activities. Investigators work within a dynamic team of data analysts and other investigators to identify potential cases, develop supporting investigative and background details, and interview consumers to verify case facts. In this role, you will:

+ Work collaboratively within a team of ACA policy subject matter experts (SMEs) and data analysts to develop approaches to identify and research potential FWA.

+ Actively participate in the development of lead and investigation workflows and required data capture within a case management system.

+ As needed, develop Investigative Plans of Action (IPOAs) and, with CMS approval, implement the plan with the support of other Investigators using techniques that may include reactive data analysis, audits, interviews, secret shopping, site visits, etc.

+ Multi-task by working on 5 – 7 cases that are in different investigative stages simultaneously

+ Within a case management system, comprehensively document all lead and investigative activity in detail.

+ Compile recommendations for actions that CMS might take for each case.

+ Conduct interviews with complainants and/or consumers to obtain information to support potential FWA activity.

+ Analyze and evaluate enrollment data.

+ Actively support preparation of comprehensive CMS-required reports on the st

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Job Posting: JC185599460

Posted On: Jun 12, 2021

Updated On: Jun 27, 2021