Healthcare Fraud Analytics Analyst

Mass General Brigham Health Plan; Somerville (MA); Hybrid; USD 64,000 - 93,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Fraud Analyst to build data analytics for the SIU, creating SQL queries against claims data, compiling regulatory reports, and producing actionable reports for investigators.

The ideal candidate has strong SQL skills and a healthcare fraud investigations background. This hybrid role, based in Somerville, MA, emphasizes data-driven investigations, documentation, and collaboration with cross-functional teams.

Qualifications

• 2-3 years of experience investigating claims or compliance.
• 2-3 years of experience as an analyst in healthcare, data reporting or data analysis.
• Healthcare fraud experience highly preferred.
• Data analysis with SQL proficiency highly preferred.

Responsibilities

• Develop and run reports, analyze data to identify suspicious billing patterns, assess the merits of allegations, and present those findings to leadership.
• Analyze claims data to find suspicious billing patterns and outliers, using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerabilities.
• Conduct preliminary investigations to assess the merits of allegations through fact-gathering and analyses of data sets.
• Organize data and document preliminary investigative steps with a high level of detail and accuracy to clearly and concisely support investigative inferences, conclusions, and recommendations.
• Report discoveries of fraud or program abuse to external parties, as required by law, rule, or contract.
• Receive investigative requests from field staff, internal claims associates, and underwriting.

Skills

SQL proficiency

Healthcare fraud experience

Analytical thinking

Communication skills

Education

Bachelor's Degree

Job description

Mass General Brigham Health Plan is seeking a Fraud Analyst to build data analytics for the SIU, creating SQL queries against claims data, compiling regulatory reports, and producing actionable reports for investigators.

The ideal candidate has strong SQL skills and a healthcare fraud investigations background. This hybrid role, based in Somerville, MA, emphasizes data-driven investigations, documentation, and collaboration with cross-functional teams.