Healthcare SIU Fraud Investigator & Analytics

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Hybrid; USD 80,000 - 116,000; Full time

Benefits offered by this job

Flexible work options

Job summary

Mass General Brigham Health Plan Holding Company, Inc. seeks a Data Analyst focused on fraud, waste and abuse investigations. The role conducts confidential investigations, data analysis, and public records research to identify improper claim submissions.

The position emphasizes documentation, interviews, and reporting within a hybrid on-site schedule in Somerville, MA. The candidate will review policies, provider manuals, and BD's to support findings and stay current with industry trends in

Qualifications

• Bachelor's Degree in a related field is required.
• 5–7 years of experience conducting fraud, waste, and abuse investigations.
• Strong aptitude for technology-based solutions.
• Excellent leadership and communication skills.
• Ability to translate complex topics for diverse audiences.
• Excellent interpersonal skills.

Responsibilities

• Conduct confidential investigations of suspected fraud, waste & abuse.
• Perform data analysis, public records research, document review, and interviews.
• Review payment policies, medical policies, and provider manuals related to claim submissions.
• Obtain investigative evidence by requesting documents and interviewing providers, members, or other parties.
• Analyze multiple data sources and prepare case summaries and interview reports.
• Stay up to date with industry trends in fraud, waste & abuse.

Skills

Data analysis

Public records research

Interviewing

Documentation

Leadership

Communication

Education

Bachelor's degree in a related field

Job description

Mass General Brigham Health Plan Holding Company, Inc. seeks a Data Analyst focused on fraud, waste and abuse investigations. The role conducts confidential investigations, data analysis, and public records research to identify improper claim submissions.

The position emphasizes documentation, interviews, and reporting within a hybrid on-site schedule in Somerville, MA. The candidate will review policies, provider manuals, and BD's to support findings and stay current with industry trends in