Director, Federal Healthcare Program Integrity & Advanced Analytics

Analytica; United States; Remote; USD 180,000 - 240,000; Full time

Benefits offered by this job

Bonuses

Employer-paid health care

Training funds

401k match

Job summary

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

The role requires expertise in healthcare data domains, AI-driven insights, and translating findings into actionable recommendations for CMS, DHA, VA, and other federal entities.

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 (CMS, DHA, MHS/TRICARE, HHS OIG, DOJ healthcare fraud initiatives, or Medicaid).
• Deep experience with federal healthcare domains (Medicaid/Medicare/TRICARE).
• Experience supporting healthcare fraud investigations or developing fraud indicators and risk models.
• Experience evaluating program-integrity interventions and translating analytics into actionable decisions.
• Experience with modern analytics environments and AI platforms (Python/SAS/R/SQL/Databricks/Snowflake).
• Experience applying NLP, LLMs, OCR, semantic analysis, network/link analysis to healthcare/investigative data.
• Familiarity with responsible AI, model validation, privacy, and data governance.
• Experience contributing to federal solution development, capture, proposals, client engagement.

Responsibilities

• Lead development of advanced analytics and investigative capabilities for federal health programs.
• Translate analytical findings into actionable recommendations for clients and stakeholders.
• Oversee cross-functional teams including investigators, clinicians, auditors, and data scientists.
• Support business growth, capture efforts, and proposal initiatives through analytical leadership.

Skills

Leadership

Client-facing

Communication

Data-driven decision making

Healthcare program integrity

Advanced analytics

AI/ML concepts

Education

Master's degree or doctorate in a quantitative/healthcare/policy field

Tools

Python

SAS

R

SQL

Databricks/Snowflake

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

• * 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 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-growingcompanies 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.

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.

When receiving email communication from Analytica, please ensure that the email domain is analytica.net to verify its authenticity.