What are the responsibilities and job description for the Senior Manager, Federal Healthcare Program Integrity & Advanced Analytics position at Analytica?
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 Analytica’s 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 Analytica’s capture and proposal efforts.
Required Qualifications:
- Master’s 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.
- Recognized healthcare/program-integrity thought leadership through client leadership, publications, presentations, professional associations, government working groups, or industry forums
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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