Program Integrity Analyst
HQ/Washington, DC
Operations – CMS Program /
Full-time /
Remote
Who is Element?
We serve as a partner at the intersection of innovation and our clients' needs, efficiently crafting meaningful user experiences for government and commercial customers. By breaking down complex problems to their fundamental elements, we create modern digital solutions that drive efficiencies, maximize taxpayer dollars, and deliver essential outcomes that serve the people.
Why Work at Element?
Make an impact that resonates-join our vibrant team and discover how you can improve lives through digital transformation. Our talented professionals bring unparalleled energy engagement, setting a higher standard for impactful work. Come be a part of our team and shape a better future.
Position Overview
Element is looking for an experienced Program Integrity Analyst. As a Program Integrity Analyst, the candidate will directly support Element’s fraud detection and investigation program focused on misleading marketing detection, and insurance agent and broker oversight. The Program Integrity Analyst will work directly with a technical team focused on implementing data scraping and analysis tooling to advise them as a subject matter expert on innovative detection methodologies as well as guidance on proper auditing of digital evidence collected. As a member of this project, you will help ensure the delivery of healthcare to millions of Americans by monitoring and preventing fraud, waste, and abuse.
Prior experience with healthcare insurance fraud detection and investigation or regulatory compliance investigations is highly desirable.
Key Responsibilities
- Design and maintain data collection protocols and ensure all gathered data meets admissibility standards for administrative proceedings or regulatory action.
- Design and implement audit trails for all data collection activities, including web scraping, enrollment data analysis, and marketing material capture.
- Create documentation standards for all data collection and ensure that standards support enforcement actionsValidate that all data collection complies with privacy regulations, data use agreements, and other regulatory requirements.
- Guide the technical team in identifying new data source and collection methods for detection fraud patterns.
- Develop playbooks for different fraud and abuse typologies.
- Design correlation strategies across multiple data sources.
- Help develop confidence scoring methodologies for fraud or abuse indicators.
- Collaborate with data scientists to define detection rules and anomaly patterns based on known fraud schemes.
Minimal Qualifications
- Bachelor’s degree in Cybersecurity, Information Assurance, Digital Forensics, or a related field.
- 5+ years of hands-on experience in fraud investigations, digital forensics, or regulatory compliance.
- Understanding of data privacy regulations and federal records management requirements.
- Familiarity with NIST Cybersecurity Framework (CSF), FISMA, and other federal cybersecurity standards.
- Excellent analytical thinking and written/verbal communication skills with the ability to brief executive audiences.
Preferred Qualifications
- Understanding of database structures and data correlation techniques.
- Prior experience supporting healthcare focused fraud or abuse investigations.
- Experience working with Medicare/Medicaid or ACA program integrity initiatives.
- Ability to transform technical data and indicators into executive-level narratives that inform strategic decisions.
- Exceptional verbal and written communication skills with the ability to build trust across diverse teams.
$180,000 - $240,000 an hour
The likely salary range for this position is $180,000-$240,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
Location
Be in your Element residing anywhere in the Continental US. We are a remote-first company based in Washington, DC.
Element is an Equal Opportunity Employer all qualified applicants will receive consideration for employment without regard to age, ancestry, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, marital status, protected veteran status, or any other legally protected class.
We believe in a world where solutions we build improve the lives of those who use them.
