Job Description

Marketplace Investigator

The Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance Marketplace) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), the Centers for Medicare & Medicaid Services (CMS) has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance agents, brokers, and others who assist with FFM enrollments. The Marketplace Program Integrity Contract (MPIC) is designed to support this oversight. Through research, investigation, and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative actions to CMS; and recommend referrals to law enforcement if potential fraud and abuse is identified.

How You Will Make An Impact:

• 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.
• 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.

What You'll Need To Succeed:

• 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

Value-Add Experience - Preferred Skills:

• Experience with FWA claims and investigations

Location:

• Remote

Residency/background:

• Must be able to pass a CMS background check, which requires residency in the U.S. for 3 of the last 5 years.

GDIT IS YOUR PLACE:

• 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

The likely salary range for this position is $69,700 - $94,300. 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. Scheduled Weekly Hours: 40 Travel Required: Less than 10% Telecommuting Options: Remote Work Location: Any Location / Remote

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