Healthcare Fraud Investigator | Data-Driven & Hybrid

Mass General Brigham; Somerville (MA); Hybrid; USD 69,000 - 116,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Data Analyst to lead investigations into suspected fraud, waste, and abuse. The role includes data analysis, public records reviews, and documenting findings in concise reports.

You will examine provider and member information, contracts, and policies to identify questionable submissions, delivering actionable recommendations. This full-time, hybrid position is based in Somerville with on-site days at Assembly Row and ongoing collaboration across

Qualifications

• Bachelor’s degree required; experience can be considered in lieu of degree.
• At least 5–7 years of experience in fraud, waste, and abuse investigations.
• Strong ability to translate complex topics for diverse audiences.

Responsibilities

• Conduct confidential investigations of suspected fraud, waste & abuse (FWA).
• Perform data analysis, public records research, document review, and interviews.
• Interpret payment policies, provider manuals, benefits documents, and clinical guidelines.
• Obtain investigative evidence through documents and interviews with providers or members.
• Analyze multiple data sources: claims, contracts, and financial data.
• Produce timely investigative plans, case summaries, and interview reports.

Skills

Data analysis

Investigations

Report writing

Communication

Team leadership

Public records research

Education

Bachelor’s Degree Related Field of Study

Job description

Mass General Brigham Health Plan is seeking a Data Analyst to lead investigations into suspected fraud, waste, and abuse. The role includes data analysis, public records reviews, and documenting findings in concise reports.

You will examine provider and member information, contracts, and policies to identify questionable submissions, delivering actionable recommendations. This full-time, hybrid position is based in Somerville with on-site days at Assembly Row and ongoing collaboration across