Description

Job Family Technology Consulting Travel Required Up to 25% Clearance Required None This requisition has been posted for the purpose of pipelining building relationships with qualified candidates in order to potentially hire them into future openings within FFI (Financial Crime, Fraud, and Investigative Services) Technology. FFI Technology is currently proactively gathering and engaging candidates of interest and will then be able to match them with positions that become available in the future. What You Will Do Work on technical teams that guide clients through the selection, implementation, testing, and calibration/tuning of healthcare fraud technology solutions for Life Sciences companies, Public Health Agencies, and Provider and Payer Organizations. Query healthcare datasets with the intent to assist with designing processes to define characteristics of different fraud typologies relevant to healthcare and collaborate with cross-functional teams to drive improvements of existing tools, processes, and models related to fraud management. Identify, research, and organize electronic information to assess the appropriateness and sufficiency of data to facilitate effective analysis. Analyze and interpret historical healthcare data related to claims and payor/provider information. Analyze large amounts of data from numerous internal and external sources and produce authoritative reports and root-cause analysis on fraudulent activities. Identify, investigate, and monitor fraudulent or anomalous activity, including isolating and quantifying specific trends driving changes to fraud and payment patterns. Design and implement fraud rules and models, including historical back testing analysis, offline evaluation and production performance impact monitoring. Work with and optimize third-party vendor solutions to resolve client issues (e.g., rules tuning, model validation, etc.). Analyze batch input and output data for Quality Control purposes, trends analysis, etc. to ensure optimal output performance. Prepare reports, written analyses, quantitative exhibits, and other client deliverable regarding project and/or results of work performed. Maintain detailed working records reflecting assumptions, methodologies, and information sources employed during the performance of all analytical tasks. Participate in client meetings to review results of work performed. What You Will Need Bachelor's degree. A minimum 1-3 years of prior relevant fraud experience. A minimum 1-3 years of prior experience with Health Care data analytics. Able and willing to relocate to either the NYC or DMV area at own expense if not currently based there. Able and willing to come into Guidehouse's NYC or Tysons Corner (McLean, VA) office for internal meetings and work at clients' locations when required. Able to perform ad-hoc analysis in real time using T-SQL queries. Experience developing complex functions and stored procedures. Familiar with designing and working with database objects including tables, relationships, constraints, triggers and views. In-depth knowledge of standard concepts, practices and procedures related to database management. Ability to independently analyze and gather insights from data in real time. Knowledge of statistical methods & scripting (SQL, Snowflake or Redshift); Python or R, PowerShell a plus. Experience with visualization of data including Tibco Spotfire, Tableau, R, PowerPivot, PowerBI, Excel and others. Processes to transform and load various structured data formats. Intellectual curiosity and the ability to ask probing, thoughtful questions and examine data from all angles/perspectives. Able to manage several projects simultaneously and autonomously. Strong conceptual as well as quantitative and qualitative analytical skills. Ability to travel as required based on engagements. What Would Be Nice To Have Master’s degree. Experience in a management consulting/advisory company. Experience with fraud software vendors servicing the financial crimes market. Experience with data science, machine learning, and statistics. Experience with Healthcare systems such as EPIC.

Role and Responsibilities

• What You Will Do Work on technical teams that guide clients through the selection, implementation, testing, and calibration/tuning of healthcare fraud technology solutions for Life Sciences companies, Public Health Agencies, and Provider and Payer Organizations. Query healthcare datasets with the intent to assist with designing processes to define characteristics of different fraud typologies relevant to healthcare and collaborate with cross-functional teams to drive improvements of existing tools, processes, and models related to fraud management. Identify, research, and organize electronic information to assess the appropriateness and sufficiency of data to facilitate effective analysis. Analyze and interpret historical healthcare data related to claims and payor/provider information. Analyze large amounts of data from numerous internal and external sources and produce authoritative reports and root-cause analysis on fraudulent activities. Identify, investigate, and monitor fraudulent or anomalous activity, including isolating and quantifying specific trends driving changes to fraud and payment patterns. Design and implement fraud rules and models, including historical back testing analysis, offline evaluation and production performance impact monitoring. Work with and optimize third-party vendor solutions to resolve client issues (e.g., rules tuning, model validation, etc.). Analyze batch input and output data for Quality Control purposes, trends analysis, etc. to ensure optimal output performance. Prepare reports, written analyses, quantitative exhibits, and other client deliverable regarding project and/or results of work performed. Maintain detailed working records reflecting assumptions, methodologies, and information sources employed during the performance of all analytical tasks. Participate in client meetings to review results of work performed.