Fraud, Waste & Abuse Investigator (Hybrid)

Mass General Brigham Incorporated; Somerville (MA); Hybrid; USD 80,000 - 116,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking an SIU Fraud Investigator for a hybrid role in Somerville, MA. The position is full-time with on-site presence about once per month.

The role focuses on creating, refining, and performing analytic reporting to identify potential fraud, waste, or abuse in claim submissions, including researching providers and members and documenting findings in reports.

Qualifications

• Bachelor's Degree in a Related Field required; experience may be considered in lieu of degree.
• 5-7 years of experience conducting fraud, waste, and abuse investigations required.
• Strong communication and leadership abilities; ability to translate complex topics for diverse audiences.

Responsibilities

• Conduct confidential investigations of suspected fraud, waste & abuse involving providers, members or other parties.
• Perform data analysis, public records research, document review and interviews.
• Review payment policies, provider manuals, benefits documents, and regulations related to claim submissions.
• Obtain investigative evidence through document requests and interviews; document findings clearly.
• Stay updated on trends in fraud, waste & abuse schemes and produce timely reports.

Skills

Fraud investigation

Data analysis

Public records research

Interviews

Communication

Leadership

Education

Bachelor's degree in related field

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking an SIU Fraud Investigator for a hybrid role in Somerville, MA. The position is full-time with on-site presence about once per month.

The role focuses on creating, refining, and performing analytic reporting to identify potential fraud, waste, or abuse in claim submissions, including researching providers and members and documenting findings in reports.