General Dynamics Information Technology · 5 hours ago
Marketplace Investigator
Any Location / Remote
Full-time
Remote
Mid Level
$61K/yr - $80K/yr
3+ years exp
Maximize your interview chancesInformation Technology
No H1B
U.S. Citizen OnlySecurity Clearance Required
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Responsibilities
Conducts analysis, research, and outreach in support of an MPIC Team.
Research includes review of documents and data; outreach includes interaction with consumers, insurance agents/brokers, and other agencies; analysis includes applying regulations to findings and analysis of data, including enrollment data related to consumer and Agent/Broker activity within the health insurance exchange.
Completes and/or supports the preparation of comprehensive reports on the results of analysis and other work completed by team members.
Conducts other data analysis and documentation support as needed.
Will focus on reviewing documents provided by agent/brokers in response to Marketplace registration/agreement suspension or termination and preparing recommendation based on review conducted.
Work collaboratively within a team of ACA policy subject matter experts (SMEs) and data analysts.
Actively participate in the development of lead and investigation workflows and required data capture within a case management system.
Strictly follow approved Standard Operating Procedures (SOPs) for conducting investigations and provide input into recommendations for SOP updates as needed.
Prioritize, evaluate, and analyze information for potential fraud, waste, and abuse (FWA) using data related to consumer enrollments into qualified health plans and/or the associated agents/brokers’ compliance with regulations.
Analyze and evaluate enrollment data related to consumer and Agent/Broker activity within the Marketplace.
As needed, initiate and develop an Investigative Plan of Action (IPOA) and with CMS approval, implement the plan with the support of investigative staff into the potential FWA behavior using various investigative techniques.
As needed, initiate and develop a Case Summary report, which summarizes investigative findings.
As needed, make administrative recommendations to CMS based on case summary findings.
Within a case management and tracking system, comprehensively document in detail all lead and investigative activity.
As needed, conduct interviews with complainants and/or consumers and with CMS approval correspond with agents/brokers or other government agencies using CMS-approved template.
Actively support preparation of comprehensive reports on the status of leads and investigations as required by CMS.
As needed, assist in ad-hoc educational and outreach sessions with partners, e.g., CMS, law enforcement, Agent/Brokers, Navigators, etc.
Safeguard PII and PHI.
Infrequent travel may be required.
Qualification
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Required
Evaluate Information
Microsoft Office
Researching
3 + years of related experience
Bachelor’s degree or equivalent experience in healthcare field that includes 2-4 years’ ACA and/or Medicaid-Medicare experience
2+ years’ experience with and/or understanding of ACA policies and regulations related to consumer enrollments requirements and Agent/Broker and Navigator responsibilities
Frequent work with workgroups to successful completion of goals and milestones
Experience reviewing complex data reports
Highly organized, ability to multi-task, and meet deadlines
Proficient in computer skills, for example Microsoft Office-Word, Excel
Requires only limited oversight to conduct work
Strong inter-personal and communications skills, both written and oral
Experience in conducting telephonic and in-person interviews
Ability to conceptualize, solve problems, and draw conclusions
Must be able to pass a CMS background check, which requires residency in the U.S. for 3 of the last 5 years.
Preferred
Experience with FWA claims and investigations
Benefits
401K with company match
Comprehensive health and wellness packages
Internal mobility team dedicated to helping you own your career
Professional growth opportunities including paid education and certifications
Cutting-edge technology you can learn from
Rest and recharge with paid vacation and holidays
Variety of medical plan options, some with Health Savings Accounts
Dental plan options
Vision plan
Ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match
Full flex work weeks where possible
Variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year
Paid leave and paid holidays are prorated based on the employee’s date of hire
The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees
Short and long-term disability benefits
Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance
Company
General Dynamics Information Technology
General Dynamics Information Technology has worked across the full spectrum of government and business for decades. It is a sub-organization of General Dynamics.
10,001+ employees
Funding
Current Stage
Late StageLeadership Team
Ben Buckley
Vice President, Business Area
Katharine Murphy
VP Cybersecurity, Preparedness and Enforcement
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