Location: Nashville, TN
ANALYTICA is seeking an experienced Statistician to perform in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. The Statistician will support the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to law enforcement, recoupment of over payment, and/or administrative action based on reactive and proactive data analysis.  This position is based out of Nashville, TN.

Primary Responsibilities:
  • Works with local management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests.
  • Communicates effectively with internal and external customers, including federal law enforcement officers.
  • Validates data analysis results and analytically identifies potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations.
  • Supports management requests for CMS reporting requirements.
  • Utilizes data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seeks out and develops leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources.
  • Works with Statisticians and Sr. Data Analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, overpayments, and/or administrative actions.
  • Prepares, develops and participates in provider, beneficiary, law enforcement, or staff training as related to Medicare fraud, waste and/or abuse data analysis.
  • Maintains chain of custody on all documents and follow all confidentiality and security guidelines.
  • Complies with and maintains various documentation and other reporting requirements as needed.
  • Masters degree in statistics or related discipline with preference given to candidates with relevant work experience in healthcare claims analysis
  • Must have and maintain a valid driver’s license issued by his/her state of residence
  • Have high proficiency level with MS Access and MS Excel.
  • Requires a working knowledge of SAS and/or other applications to perform various types of data analysis.
  • Knowledge of Medicare and Medicaid rules and regulation is a plus
  • Demonstrated knowledge of various database management systems in order to input, extract or manipulate information.
  • Demonstrated experience and knowledge of health care information (health claims data specifically Medicare and Medicaid, ICD-9-CM codes, physician specialty codes, pharmaceutical data including NCPDP file formats and codes, provider identifiers, etc) is preferred.

About ANALYTICA:  The company is a rapidly growing SBA certified 8 (a) and HUBZone firm providing technology and consulting solutions that assist clients in managing, analyzing, and protecting information. Headquartered in Washington DC, ANALYTICA provides a dynamic, entrepreneurial environment for career development. For additional career opportunities please visit:
this job portal is powered by CATS