Fraud Business Analyst SME

Fraud Business Analyst SME

Remote work

Preferred: US Citizenship

• Ability to obtain and maintain an HHS Background Investigation (Public Trust) suitability determination.

Key Responsibilities

Requirements Elicitation and Traceability

• Facilitate structured requirements workshops with HRSA program stakeholders (OIG, Grants Division, FDMP program office) to elicit and document business requirements for fraud detection, anomaly flagging, and case management workflows.

• Translate business requirements into user stories, acceptance criteria, and process flows; maintain a traceable requirements matrix (RTM) throughout the EPLC lifecycle.

• Review and validate EPLC planning deliverables (Business Requirements Documents, Concept of Operations, System Requirements Specifications) to ensure they accurately reflect HRSA’s fraud detection intent.

Fraud Domain SME Support

• Apply working knowledge of federal grant fraud, waste, and abuse (FWA) patterns to inform model design decisions: improper payment types, duplicate entity schemes, inflated cost reports, and sub-awardee integrity risks across HRSA grant programs.

• Support the AI/ML Lead Engineer in defining supervised classification labels, anomaly detection thresholds, and SHAP feature interpretation from a business-rules perspective.

• Validate model outputs and HITL review queues against known FWA patterns; flag false-positive risks and provide business-logic guardrails to data science team.

• Contribute to the design of the Portfolio Risk Manager agent’s risk scoring logic and grantee-level threshold calibration; ensure scoring outputs are interpretable and defensible for HRSA investigators.

Agile Delivery and Sprint Governance

• Own and maintain the product backlog in coordination with the Program Manager and AI/ML Lead Engineer; write well-formed user stories and acceptance criteria for all sprint deliverables.

• Facilitate Agile ceremonies including sprint planning, backlog refinement, sprint review, and retrospective in accordance with the program’s SAFe-aligned delivery cadence.

• Coordinate with HRSA stakeholders to prioritize backlog items based on fraud risk impact, EPLC gate requirements, and HRSA program office readiness.

Stakeholder Liaison and Communication

• Serve as the primary liaison between HRSA fraud program offices and the technical delivery team; translate government feedback from sprint reviews into actionable backlog items.

• Prepare and present sprint demo materials and stakeholder briefing summaries; document HRSA decisions and action items from all program meetings.

• Support the Program Manager in producing required EPLC deliverables that require business input: Use Case Documents, Interface Requirements Specifications, and Transition Plans.

HITL Workflow Design Support

• Collaborate with the AI Agent / HITL Engineer to design analyst-facing review queues in UiPath Apps; define case prioritization logic, routing rules, and disposition workflow requirements.

• Document HRSA analyst workflow patterns and configure HITL interface requirements so that AI-generated risk flags are presented in context usable for real-world fraud investigations.

Requirements:
Required Qualifications

• Bachelor’s degree in Business Administration, Public Administration, Health Informatics, Information Systems, or a closely related field.

• Minimum 4 years of experience as a business analyst, program analyst, or requirements analyst on federal IT or health program contracts.

• Demonstrated experience supporting HHS, CMS, OIG, HRSA, or comparable civilian agency programs with a focus on grants management, improper payments, or program integrity.

• Working knowledge of federal fraud, waste, and abuse (FWA) frameworks: HHS OIG guidance, Improper Payments Elimination and Recovery Improvement Act (IPERIA), or equivalent.

• Experience writing user stories and acceptance criteria for Agile/SAFe delivery teams; familiarity with tools such as Jira, Azure DevOps, or equivalent backlog management platforms.

• Ability to facilitate requirements workshops and stakeholder meetings with federal government program offices; strong verbal and written communication skills.