Key Responsibilities
- Define and document rule-based detection criteria based on industry fraud patterns.
- Collaborate with stakeholders to understand existing investigation techniques and develop innovative monitoring and detection techniques.
- Test and validate detection algorithm outputs for accuracy and relevance.
- Create comprehensive user documentation and training materials.
- Coordinate pilot implementation and user acceptance testing.
- Analyze false positive rates and recommend threshold adjustments.
- Document business requirements and user stories.
- Facilitate stakeholder meetings and requirement gathering sessions.
- Support change management and user adoption activities.
Minimal Requirements
- Bachelor's degree in Business Administration, Analytics, or related field.
- 4+ years of relevant work experience, including project management experience, preferably in healthcare or insurance.
- Strong analytical and problem-solving skills.
- Experience with fraud detection or risk management systems.
- Excellent written and verbal communication skills.
- Ability to translate technical concepts for non-technical stakeholders.
- Experience with requirements gathering and documentation.
- Knowledge of testing methodologies and UAT processes.
- Proficiency in data analysis tools and techniques.
- Experience with Agile/Scrum methodologies.
- US Citizenship or Permanent Residency required.
- Must reside in the Continental US.
- Depending on the government agency, specific requirements may include public trust background check or security clearance.
Preferred Qualifications
- Knowledge of insurance broker regulations and compliance requirements.
- Background in fraud investigation or risk assessment.
Similar Jobs
What We Do
We are your human-centric innovation partner, crafting impactful user experiences for government and commercial sectors with an unwavering commitment to efficiency and excellence. Our Core Capabilities: CMS Data Experience Our team has established deep domain experience in insurance, claims, and quality data throughout the CMS ecosystem. We equip healthcare stakeholders with insights to make informed policy decisions through strategic data management, integrating diverse data sources, and conducting analysis. Enabling Interoperability in Healthcare We build functionality using standards such as FHIR to allow for data interoperability between government agencies, providers, and patients. Guided by our long-time partnership with CMS and healthcare stakeholders, we advocate for patient data accessibility, striving to enhance the quality of care delivered. Leaders in DevSecOps As some of the earliest practitioners of DevSecOps within CMS, we exemplify the significance of a carefully engineered CI/CD pipeline. Amidst unprecedented HealthCare.gov registrations, our team safeguards its stability and reliability. Consulting to Innovate At Element, we act as consultative partners at the crossroads of innovation and our clients' needs. No matter the challenge, we identify and prioritize the appropriate methods, ensuring tailored solutions and using modern technologies. We believe in a world where solutions we build improve the lives of those who use them, and the elements of Innovation, Collaboration, Integrity, Equity, Creativity are the foundation
