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About the Role
The incumbent is responsible for investigating fraudulent claims, transactions, and complaints of unlawful receipt of funds within public assistance programs in Massachusetts. This involves analyzing data using various tools and techniques to detect fraud, identify trends, and communicate findings to management.
Responsibilities
- Work with BSI, Audit Operations, and OSA’s IT Department to identify data and analysis requirements for reports and data analysis projects.
- Proactively monitor and review electronic account and transaction data for suspicious activity and possible fraud.
- Identify and document existing trends and patterns in Medicaid claim data, Electronic Benefits Transfer (EBT) card transactional data, and other data sets.
- Analyze complex internal and external data to identify anomalies, outliers, trends, and behaviors indicating increased risk for fraud, waste, or abuse.
- Document data models and protocols for mining production databases.
- Identify data sources and fields for reports, mapping, and computations required for metrics.
- Review, investigate, and resolve irregular transactions and identify areas needing increased security controls.
- Apply quality assurance best practices for data mining and analysis services.
- Develop, implement, and maintain change control and testing processes for data model modifications.
- Keep detailed records of suspicious activity, analyze trends, communicate security threats to management, and provide recommendations for loss mitigation.
- Meet regularly with Assistant Director regarding investigations and adhere to timelines.
- Collaborate with staff at all levels throughout the OSA as necessary to perform data analysis tasks.
- Develop SQL queries to extract, manipulate, and summarize information.
- Ensure compliance with HIPAA and other Federal and State data policies/best practices.
- Address ad-hoc analytics requests to support projects.
- Prepare written summaries with supporting documentation and data to accompany analysis results.
- Explain clearly what the data and results indicate and how they can be utilized to support project objectives.
- Maintain up-to-date skills in new languages, tools, and technologies.
Requirements
- At least three (3) years’ experience in investigations, research, analytics or related field.
- Experience in the investigation of fraud in public benefits or other white-collar crimes.
- Experience with, or understanding of, Medicaid claims data and/or Department of Transitional Assistance transactional and eligibility data.
- Proficient in SQL and demonstrated ability in data analysis, business intelligence and visualization tools (i.e. QlikView/Sense, Tableau or alternative data visualization package).
- At least 5 years full time or equivalent part-time experience, the major duties of which included: experience in investigations, auditing, data analysis, or has assisted in the development of investigative findings and/or the preparation of audit reports.
- Participation in investigative engagements, or complex or specialized investigations requiring the application of technical knowledge and expertise.
- Experience translating complex quantitative analysis to a non-technical audience.
- Professional licensure or certification in fraud-related field.
Skills
- Data analysis
- Business intelligence
- Data visualization
- SQL
- Fraud investigation
- HIPAA compliance
Location
- Boston
- Lawrence
- Quincy
- Brockton
- Marlboro
- Chicopee
Work Type
- Full-time
Experience Level
- Commensurate with experience
- At least three (3) years’ experience
- At least 5 years full time or equivalent part-time experience
Education Level
- Master’s degree in criminal justice, public policy, public administration or a related field
Salary/Compensations
- $61,466.46/yr. -- $92,200.45/yr.
About the Company
- The Office of the State Auditor is committed to providing equal employment opportunities.
Equal Opportunity
- Employment actions such as recruiting, hiring, training, and promoting individuals are based upon a policy of non-discrimination.
- Employment decisions and actions are made without regard to race, color, gender, religion, age, national origin, ancestry, sexual orientation, gender identity and expression, disability, military status, genetic information, political affiliation, or veteran’s status.