Ombudsman - Mission Success (Fraud Analytics & Program Integrity)

CACI • Baltimore, MD

14d

About The Position

The Opportunity: CACI Federal is seeking a Mission Success–oriented Ombudsman to serve as a trusted, independent authority focused on improving program integrity, fraud detection, and service delivery effectiveness across healthcare operations. This role will champion fairness, transparency, and accountability, while leveraging advanced fraud analytics, AI-enabled insights, and data-driven oversight to identify systemic risks, detect improper payments, and enhance mission outcomes. The Ombudsman will play a critical role in ensuring that patient, provider, and stakeholder concerns are resolved while proactively identifying fraud patterns and operational vulnerabilities.

Requirements

• College degree (B.S. or greater) in business administration or a related discipline (Experience may be accepted in lieu of degree)
• 10+ years related experience; particularly working on government contracts
• Executive leadership experience in large-scale healthcare, federal programs, or program integrity operations
• Demonstrated experience in fraud analytics, improper payment reduction, or investigative support
• Proven ability to manage complex, high-volume service environments with significant budgets and stakeholders
• Strong expertise in data analytics, predictive modeling, or AI-driven insights
• Experience in conflict resolution, stakeholder engagement, and organizational problem-solving
• Exceptional communication and executive briefing skills

Nice To Haves

• Civilian healthcare programs experience (CMS, VA, TRICARE, or large payer systems)
• Background in healthcare fraud, waste, and abuse detection or program integrity analytics
• Experience with AI/ML, anomaly detection, or network analysis for fraud identification
• Familiarity with data platforms, BI tools (e.g., Tableau), and large-scale data environments
• Experience supporting audits, investigations, or law enforcement collaboration

Responsibilities

• Mission Support, Advocacy & Program Integrity: Serve as an independent, neutral resource for resolving patient, provider, and stakeholder concerns. Promote equitable treatment while safeguarding program integrity and public trust. Identify systemic vulnerabilities that may lead to fraud, waste, or abuse.
• Fraud Analytics & Risk Detection: Lead the identification and analysis of fraud, waste, and abuse patterns across healthcare claims, provider activity, and payment systems. Leverage machine learning, anomaly detection, and predictive analytics to proactively identify high-risk behaviors and improper payments. Integrate multi-source data (claims, financial records, provider, and external datasets) to uncover hidden relationships and fraud networks. Partner with investigative, audit, and compliance teams to support case development and resolution.
• Data-Driven Insights & Decision Support Advocate use of dashboards and reporting to track fraud trends, complaint patterns, and operational risks. Translate analytics into actionable insights for senior leadership and oversight bodies. Enable real-time visibility into program health, integrity risks, and performance gaps.
• Operational Excellence & Continuous Improvement Analyze root causes of complaints, appeals, and fraud-related issues to recommend systemic fixes. Drive improvements that reduce improper payments, streamline adjudication, and improve service quality. Implement continuous feedback loops to strengthen fraud prevention and detection mechanisms.
• Program Oversight & Governance: Ensure compliance with federal healthcare regulations, privacy requirements, and program integrity standards. Support audits, investigations, and continuous monitoring initiatives. Provide executive-level briefings on fraud risks, mitigation strategies, and operational performance.

Benefits

• Our employees value the flexibility at CACI that allows them to balance quality work and their personal lives. We offer competitive compensation, benefits and learning and development opportunities. Our broad and competitive mix of benefits options is designed to support and protect employees and their families. At CACI, you will receive comprehensive benefits such as; healthcare, wellness, financial, retirement, family support, continuing education, and time off benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 5,001-10,000 employees