Healthcare Fraud Analytics Analyst (Hybrid • SQL)

Mass General Brigham Health Plan Holding Company, Inc.; 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, crafting SQL queries against claims data, and supporting regulatory reporting. The role requires experience in healthcare fraud investigations, data analysis with SQL, and knowledge of CPT/HCPCS/ICD10 codes; hybrid position with onsite monthly in Somerville, MA.

You will conduct preliminary research, document analytic steps, and present findings to leadership, supporting investigators and ensuring

Qualifications

• Bachelor's Degree required.
• 2-3 years investigating claims or compliance required.
• Healthcare fraud experience highly preferred.
• Data analysis with SQL proficiency highly preferred.
• Knowledge of CPT, HCPCS, ICD10-CM codes required.

Responsibilities

• Develop and run reports, analyze data to identify suspicious billing patterns and present findings to leadership.
• Analyze claims data to find anomalies using healthcare coding knowledge and fraud schemes.
• Conduct preliminary investigations and document steps with detail to support inferences and recommendations.
• Report discoveries of fraud or program abuse to external parties as required by law, rule, or contract.

Skills

SQL

Data analysis

Fraud investigations

Healthcare codes

Education

Bachelor's Degree

Job description

Mass General Brigham Health Plan is seeking a Fraud Analyst to build data analytics for the SIU, crafting SQL queries against claims data, and supporting regulatory reporting. The role requires experience in healthcare fraud investigations, data analysis with SQL, and knowledge of CPT/HCPCS/ICD10 codes; hybrid position with onsite monthly in Somerville, MA.

You will conduct preliminary research, document analytic steps, and present findings to leadership, supporting investigators and ensuring