Healthcare Fraud Analytics Analyst - Hybrid (SQL)

massgeneralbrigham; 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 and generating regulatory reports. The role focuses on identifying fraudulent, wasteful, or abusive claim submissions while performing research on providers or members.

The ideal candidate has a healthcare fraud background, SQL proficiency, and strong analytical and communication skills.

Qualifications

• Bachelor's Degree is required.

Responsibilities

• Develop and run reports to identify suspicious billing patterns and present findings to leadership.
• Analyze claims data to find suspicious patterns using CPT/HCPCS/ICD10‑CM knowledge.
• Conduct preliminary investigations with data analysis to assess merits of allegations.
• Document investigative steps with detail to support inferences and recommendations.
• Report fraud discoveries to external parties as required by law, rule, or contract.
• Receive investigative requests from field staff, internal claims teams, and underwriting.

Skills

SQL proficiency

Analytical

Communication skills

Healthcare coding knowledge

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 and generating regulatory reports. The role focuses on identifying fraudulent, wasteful, or abusive claim submissions while performing research on providers or members.

The ideal candidate has a healthcare fraud background, SQL proficiency, and strong analytical and communication skills.