Director, Federal Healthcare Program Integrity & Advanced Analytics

Analytica; Bethesda (MD); On-site; USD 180,000 - 230,000; Full time

Benefits offered by this job

Bonuses

Employer-paid health care

Training and development funds

401k match

Job summary

Analytica seeks a Director, Federal Healthcare Program Integrity & Advanced Analytics to lead data-driven solutions that prevent, detect, investigate, and mitigate fraud, waste, and improper payments across federal healthcare programs.

The role is senior and client-facing, overseeing AI-driven insights, investigative support, and collaboration with investigators, clinicians, and policy experts to strengthen oversight.

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 in CMS/DHA/VA or similar.
• Deep domain experience in Medicaid, Medicare, TRICARE, or related health programs.
• Experience building 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 decisions.
• Experience with modern analytics ecosystems (Python, SAS, R, SQL, Databricks, Snowflake, cloud data platforms, ML/AI platforms, graph technologies).
• Experience applying NLP, LLMs, RAG, OCR, semantic analysis, entity resolution, network/link analysis to complex healthcare data.
• Familiarity with responsible AI, model validation and explainability, privacy, security, and data governance.

Responsibilities

• Lead delivery of data-driven solutions for federal healthcare program integrity and advanced analytics.
• Oversee development of AI-driven insights and investigative support capabilities.
• Collaborate with investigators, clinicians, auditors, policy experts, data scientists, and federal stakeholders.
• Translate analytical findings into actionable recommendations and contribute to client relationships and growth.
• Support capture efforts, proposals, and solution development for business growth.

Skills

Python

SAS

R

SQL

Databricks

Snowflake

ML/AI platforms

NLP

LLMs

OCR

Graph technologies

Privacy & security

Education

Master’s or Doctorate in a quantitative/healthcare-related field

Tools

Databricks

Snowflake

Cloud data platforms

Job description

Analytica is seeking a Director, Federal Healthcare Program Integrity & Advanced Analytics to lead the delivery of data-driven solutions that help federal healthcare organizations prevent, detect, investigate, and mitigate fraud, waste, abuse, improper payments, and other program integrity risks.

This senior, client-facing leader will oversee the development of advanced analytics, AI-driven insights, and investigative support capabilities, working closely with investigators, clinicians, auditors, policy experts, data scientists, and federal stakeholders. The role requires expertise in healthcare program integrity and the use of claims, enrollment, provider, beneficiary, payment, pharmacy, managed care, and investigative data to identify risks, support investigations, and strengthen oversight.

The successful candidate will serve as a trusted advisor supporting Analytica’s work across CMS, the Defense Health Agency, the Department of Veterans Affairs, and other federal healthcare organizations. Beyond technical expertise, this individual must be able to translate analytical findings into actionable recommendations and contribute thought leadership, client relationships, and solution development to support business growth, capture efforts, and proposal initiatives.

Analytica has been recognized byInc. Magazineas one of the fastest-growing 250 businesses in the US for 3 years. We work with U.S. government clients in health, civilian, and national security missions to build better technology products thatimpactour day-to-day lives. The company offers competitive compensation with opportunities for bonuses, employer-paid health care, training and development funds, and 401kmatch.

Basic Qualifications

Analytica is seeking a Director, Federal Healthcare Program Integrity & Advanced Analytics to lead the delivery of data-driven solutions that help federal healthcare organizations prevent, detect, investigate, and mitigate fraud, waste, abuse, improper payments, and other program integrity risks.

This senior, client-facing leader will oversee the development of advanced analytics, AI-driven insights, and investigative support capabilities, working closely with investigators, clinicians, auditors, policy experts, data scientists, and federal stakeholders. The role requires expertise in healthcare program integrity and the use of claims, enrollment, provider, beneficiary, payment, pharmacy, managed care, and investigative data to identify risks, support investigations, and strengthen oversight.

The successful candidate will serve as a trusted advisor supporting Analytica’s work across CMS, the Defense Health Agency, the Department of Veterans Affairs, and other federal healthcare organizations. Beyond technical expertise, this individual must be able to translate analytical findings into actionable recommendations and contribute thought leadership, client relationships, and solution development to support business growth, capture efforts, and proposal initiatives.

Analytica has been recognized byInc. Magazineas one of the fastest-growing 250 businesses in the US for 3 years. We work with U.S. government clients in health, civilian, and national security missions to build better technology products thatimpactour day-to-day lives. The company offers competitive compensation with opportunities for bonuses, employer-paid health care, training and development funds, and 401kmatch.

Basic 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.

Preferred Qualifications

• Recognized healthcare/program-integrity thought leadership through client leadership, publications, presentations, professional associations, government working groups, or industry forums.

About Analytica

Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. The company is an award-winning SBA certified small business that hasbeen recognized by Inc. Magazine each of the past three years as one of the 250 fastest-growing companies in the U.S. Analytica specializes in providing software and systems engineering, information management, analytics & visualization, agile project management, and management consulting services. The companyis appraised by the Software Engineering Institute (SEI) at CMMI® Maturity Level 3 and is an ISO 9001:2008 certified provider.