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Job Description:

Intellisoft Technologies is a leading global information technology firm that specializes in Big Data & AI serving fortune 500 clients for the past 21 years. The company has been globally recognized for its comprehensive portfolio of services, innovation in technology, and a strong commitment to sustainability, governed by technocrats with industry experience. At Intellisoft, our professional development team helps your career by identifying the right opportunities and guide you to acquire the latest technologies in this fast-paced technology world. We believe in our employees and provide them with excellent benefits.

Job Title: Predictive Modeler (12 openings)
Location- 100% Remote
Status- Must be Green Card or US Citizen
Interview process- 1 step process and then offer
Long term contract but need to be open to converting
Clearance: Able to obtain & maintain a position of Public Trust

They MUST HAVE R EXPERIENCE TO BE CONSIDERED
These will be Data science/SAS Programmer/Data modeler type of people with a strong focus on R.
 
Must Need:
1 Lead-  Must have CMS (Center for Medicaid/Medicare) experience
7 Mid-  CMS experience but open to different backgrounds
4 Jr- $ Does not need CMS at all

Job Description:
The client has an immediate need for a Predictive Modeling Lead supporting a Leading Government Integrator.
The qualified applicant will become part of a major healthcare fraud prevention project, supporting a leading Government Healthcare organization.
The qualified applicant will drive the development of predictive models to prioritize the evaluation of possible fraudulent providers and claims.
The lead will interact with the Gov Agency and other stakeholders to develop a project development plan, build/manage predictive analytics team, and develop an innovative, efficient and effective technique to detect claims fraud.

Responsibilities:
Analyze claims data and develop requirements for sustainable predictive analytic models and edits
Working with the team and client to understand data and client needs
Detect potential weakness and vulnerabilities susceptible to fraud
Lead working groups with customers, investigators, and other contractors to elicit and evaluate vulnerabilities
Prevent FWA using system edits, policy recommendations, and customer/user education
Train Gov Agency staff and partner contractors on proactive data analysis, investigations, internet research, etc.
Assist with the analysis of vulnerabilities and data anomalies
Monitor claims and suspicious activities utilizing proven investigating techniques
Reporting and communicating regarding the effectiveness of fraud prevention activities
Build and provide oversight to the predictive analytics team.
Communicates with internal and external sources related to potentially fraudulent activity
Provides input on new ways of identifying fraud as well as improving existing fraud models
Works with technical staff to test fraud models
Participates in meetings and events representing the customer and employer
 
Requirements:
Bachelor's Degree or Higher in related field of study, and 8+ years of Data Analytics / Predictive Modeling experience for enterprise-level systems.
5+ years of experience in fraud prevention-related field(s), including fraud detection, investigation, forensic accounting, judiciary, and law enforcement
Must have direct experience with Medicare & Medicaid claims coding, processing systems, healthcare enrollment/eligibility data, as well as healthcare claims data including CPT, ICD 9 and ICD 10 codes
Expertise in one or more of the following areas:
Predictive analytics/modeling
Data mining
Machine Learning
SPSS, R, Python
Practical knowledge of insurance laws and industry regulations, Medicare program rules and regulations, as well as federal, state & local laws and ordinances pertaining to medical services and professions.
Knowledge of anti-fraud principles, Healthcare policy, & Legislation
Knowledge of the Medicare FFS programs (coverage, payment rules and regulation and claims process).
Experience with Agile project methodologies (preferably SAFe)
Exceptional communication skills both verbal & written, with end clients & key stakeholders
 
Preferred:
Doctor of Philosophy (PhD) and 7 years of related experience.
Experience with SPSS to R transformation efforts
Experience with Cloud environments such as AWS or Azure
Experience with Databricks
Experience working with customers to understand data and decision needs.
Familiarity with one or more data analysis tools, data mining tools, and/or statistical packages.
Experience analyzing complex situations and delivery advance and direction to technical staff in times of uncertainty
Goal-oriented demeanor and ability to get things done with a proactive and forward thinking approach
 
Awaiting your response,

Best Regards
Pavan Kumar Pendem
Senior Recruiter
Ph. (972) 756 1212 x EXT 144,// 469.626.6267
Pavan@intellisofttech.com
(link removed)
Intellisoft Technologies, Inc.
1320 Greenway Dive, #460. Irving, TX 75038

Equal Employment Opportunity

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizens