Program Analyst (Data Analytics)

Full Job Description

This position is located in the Criminal Division, Fraud Section, Health Care Fraud Unit.

The incumbent serves as a Program Analyst (Data Analytics) and is responsible for analyzing health care claims data, identifying anomalous billing patterns, supporting investigations, and providing subject matter expertise to prosecutors and investigative partners.

Additional selections may be made from this vacancy announcement to fill vacancies that occur subsequent to this announcement.

To qualify at the GS-12 level, applicants must have one year of specialized experience at, or equivalent to, the GS-11 Federal grade level.

Examples of specialized experience include: analyzing and interpreting data; identifying trends or patterns in data sets; validating data accuracy; and developing reports that support areas of study or investigations.

To qualify at the GS-13 level, applicants must have one year of specialized experience at, or equivalent to, the GS-12 Federal grade level.

Examples of specialized experience include: conducting complex data analysis by identifying and interpreting patterns, trends and outliers in large data sets; validating analytical findings by comparing appropriate samples; leveraging data to support areas of study or investigations; and summarizing large volumes of data into clear reports for decision makers.

Time-in-Grade: Federal employees must meet time-in-grade requirements for consideration by the closing date of this announcement. Major Duties:

• Conduct independent data analysis to identify potential new fraud investigations; complete and fulfill data analysis and information requests for law enforcement health care fraud investigations; and support and provide investigative leads.
• Apply knowledge of federal healthcare program rules, coding/claims processing systems (CPT, HCPCS, ICD), reimbursement structures, and provider and beneficiary enrollments to identify abnormalities and emerging fraud schemes.
• Design and employ appropriate algorithms to discover patterns in data sets.
• Identify patterns in claim volume, utilization, geographic distribution, or sudden changes in billing behavior that may indicate fraudulent conduct.
• Validate analytic findings using comparative analysis, sampling, and other rigorous methodologies.
• Provide expertise on program policies, claims systems, and health care benefit structures.
• Prepare written reports, presentations, and visualizations summarizing analytical results for prosecutors, management, and investigative partners.
• Provide training to DOJ staff, U.S. Attorney’s Offices, and partner agencies on health care claims data, fraud typologies, and analytic methods.