Healthcare Fraud Data Analyst

Softrams is one of the fastest growing digital services firms in the Washington Metropolitan regions crafting human-centered solutions and empowering digital services with a focus on HX, AI, cloud, DevOps and cyber security. Our offices are located in Leesburg VA, Baltimore MD, and Plano TX, and our teams are spread across the U.S.

Recognized as a Top Workplace USA (2024)

Recognized as one of the 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)

Job Description

Softrams is seeking a Healthcare Data Analyst to research program integrity vulnerabilities and develop analytical models supporting fraud prevention efforts. Work may also support efforts to evaluate healthcare outcomes and program benefits or support program operations. The selected candidate will work with a project team in support of federal clients in the Baltimore-Washington metro area.

Federal Requirements:  

• Ability to obtain a U.S. Federal Position of Trust clearance designation. 
• Must reside in and be able to perform work in the United States. 
• Must have lived in the United States for 3 of the last 5 years. 
  
  

Required Qualifications

• 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, to manipulate and analyze data and to build analytical models.
• 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 and 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.  This role may require the hired candidate to go through public clearance. A minimum of 3 years of stay in the U.S. within the last 5 years is a must to be eligible to qualify for public trust clearance sponsorship.
  
  

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.
  
  

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.
  
  

Public Trust Clearance

This role requires the hired candidate to go through public trust clearance. A minimum of 3 years of stay in the U.S. within the last 5 years is required to be eligible to qualify for public trust clearance sponsorship.

Work Location:

We have open-collaboration offices in Leesburg VA and Baltimore MD for those who may prefer to work on-site. However, Softrams is a 100% remote-first team environment. Softrams works in the eastern time zone and standard work hours are 9am ET to 5pm ET with flexibility around start and end times based on team needs.

About Softrams

Softrams is a Maryland and Virginia-based small business information technology, consulting, and solutions provider specializing in emerging technologies for UX/UI, mobile apps, DevOps, big data analytics, data science, and cyber security. We offer innovative technology implementations and build customer-centric services that are simple, intuitive, scalable, efficient and usable.

EEO Statement

Softrams, LLC. is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Softrams is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, or to participate in the job application or interview process, contact the Talent Acquisition Team at recruiting@softrams.com

Know your rights poster: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf