Senior Manager, Federal Healthcare Program Integrity & Advanced Analytics

Analytica • Bethesda, MD

2d

About The Position

Analytica is seeking a Senior Manager to lead the development and delivery of data-driven solutions that help federal healthcare organizations prevent, detect, investigate, and mitigate fraud, waste, abuse, improper payments, and other program-integrity vulnerabilities. This senior, client-facing role combines healthcare program integrity, fraud analytics, advanced analytics and AI, investigative support, and federal health growth.

The Senior Manager will work with program-integrity leaders, investigators, analysts, clinicians, auditors, policy experts, data scientists, and technology teams to translate complex healthcare fraud and integrity challenges into defensible analytical strategies, risk indicators, investigative leads, and measurable mitigation approaches. The role requires understanding how healthcare claims, encounters, enrollment, provider, beneficiary, payment, pharmacy, managed-care, and investigative data can help identify suspicious behavior, assess vulnerabilities, support investigations, improve oversight, and protect federal healthcare programs.

The position serves as a senior subject-matter leader supporting Analytica’s work and growth across CMS, the Defense Health Agency, the Department of Veterans Affairs, and adjacent federal healthcare organizations. The successful candidate will help clients turn data and analytical findings into prioritized action, and will contribute customer insight, professional relationships, technical leadership, and solution concepts to capture and proposal efforts.

Analytica is a public-sector consulting and information technology solutions provider supporting health, civilian, and national security missions. Founded in 2009 and headquartered in Bethesda, Maryland, it is an established SBA small business. The company provides software and systems engineering, information management, analytics and visualization, agile project management, and management consulting services. Analytica is appraised at CMMI Maturity Level 3 and is ISO 9001:2008 certified. Analytica is an Equal Opportunity Employer and may use AI-assisted tools to support aspects of its hiring process; hiring decisions are made by recruiters and hiring managers.

Requirements

• Master’s degree or doctorate in a relevant quantitative, healthcare, economics, public policy, informatics, or technology discipline.
• Direct experience supporting federal healthcare program integrity, fraud prevention, investigation, payment integrity, oversight, or enforcement, particularly involving CMS, DHA/Military Health System/TRICARE, HHS OIG, DOJ healthcare fraud initiatives, or state Medicaid program integrity.
• Deep experience with one or more federal healthcare domains, including Medicaid, Medicaid managed care, Medicare Fee-for-Service, Medicare Advantage, Part D, TRICARE, provider enrollment, pharmacy, or healthcare claims.
• Experience supporting healthcare fraud investigations or developing fraud indicators, risk scores, anomaly/outlier methods, entity resolution, network analysis, provider profiles, or investigative lead-generation models.
• Experience evaluating program-integrity interventions and translating analytical findings into actionable investigative, payment-integrity, or program decisions.
• Experience with modern analytics environments and technologies such as Python, SAS, R, SQL, Databricks, Snowflake, cloud data platforms, ML/AI platforms, or graph technologies.
• Experience applying NLP, LLMs, RAG, OCR, semantic analysis, entity resolution, network/link analysis, or other AI techniques to complex healthcare or investigative information.
• Familiarity with responsible AI, model validation and explainability, privacy, security, and federal healthcare data governance.
• Experience contributing to federal solution development, capture, proposals, client engagement, or growth activities.
• Established professional network within the federal healthcare, program-integrity, investigative, analytics, or government-contractor community.
• Excellent written, verbal, presentation, and facilitation skills.
• Ability to obtain and maintain the federal suitability, Public Trust, or other clearance required for assigned work.

Nice To Haves

• Recognized healthcare/program-integrity thought leadership through client leadership, publications, presentations, professional associations, government working groups, or industry forums.

Responsibilities

• Lead the development and delivery of data-driven solutions for federal healthcare program integrity.
• Help federal healthcare organizations prevent, detect, investigate, and mitigate fraud, waste, abuse, improper payments, and program-integrity vulnerabilities.
• Translate complex healthcare fraud and integrity challenges into defensible analytical strategies, risk indicators, investigative leads, and measurable mitigation approaches.
• Work with program-integrity leaders, investigators, analysts, clinicians, auditors, policy experts, data scientists, and technology teams.
• Use healthcare and investigative data to identify suspicious behavior, assess vulnerabilities, support investigations, improve oversight, and protect federal healthcare programs.
• Help clients translate analytical findings into prioritized action and actionable investigative, payment-integrity, or program decisions.
• Provide senior subject-matter leadership for Analytica’s work and growth across CMS, DHA, VA, and adjacent federal healthcare organizations.
• Contribute customer insight, professional relationships, technical leadership, and solution concepts to capture and proposal efforts.
• Evaluate program-integrity interventions and translate analytical findings into operational decisions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior