Healthcare Fraud Data Analyst - SQL & Investigations

Partner's Healthcare; Somerville (MA); Hybrid; USD 64,000 - 93,000; Full time

Benefits offered by this job

Hybrid work options

Benefits package with flexible work

Job summary

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

The role requires experience in healthcare fraud investigations, strong SQL skills, and the ability to conduct preliminary research using public records and other sources. Hybrid work, onsite meetings in Somerville, MA, and a comprehensive benefits package are offered.

Qualifications

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

Responsibilities

• Develop and run reports to identify suspicious billing patterns and present 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 data 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 data analysis

Strong communication

Analytical thinking

Education

Bachelor's Degree

Tools

SQL

Job description

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

The role requires experience in healthcare fraud investigations, strong SQL skills, and the ability to conduct preliminary research using public records and other sources. Hybrid work, onsite meetings in Somerville, MA, and a comprehensive benefits package are offered.