Data Analytics Fraud Examiner

Commonwealth of Massachusetts•Boston, MA

9d•$61,466 - $92,200•Onsite

About The Position

The Data Analytics Fraud Examiner investigates fraudulent claims, transactions, and complaints involving the unlawful receipt of funds within Massachusetts public assistance programs. The role collects, understands, and analyzes information using varied tools, databases, and data analysis techniques to detect fraud; analyzes trends and behavioral patterns; quantifies and aggregates risk; and communicates findings to management. The examiner presents conclusions in reports and answers questions about the data and findings to help the Director and Bureau of Special Investigations (BSI) staff understand the information obtained. The position works with BSI, Audit Operations, and the OSA IT Department to support data and analysis projects. It monitors transactional data for suspicious activity, investigates irregularities, develops and documents data models and protocols, creates SQL queries and reports, and provides written summaries and supporting documentation. The examiner also helps ensure compliance with HIPAA and other applicable data policies and communicates potential security threats and loss-mitigation recommendations. The role is based at one of the Office of the State Auditor’s Boston, Lawrence, Quincy, Brockton, Marlboro, or Chicopee offices. It works under the direct supervision of the Assistant Director overseeing the BSI Data Analytics team. Applications are considered only if submitted through Greenhouse.

Nice To Haves

At least three years of experience in investigations, research, analytics, or a related field.
Experience investigating 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.
Proficiency in SQL and demonstrated ability with data analysis, business intelligence, and visualization tools such as QlikView/Sense, Tableau, or an alternative visualization package.
A master’s degree in criminal justice, public policy, public administration, or a related field, or substantial professional experience: at least five years of full-time or equivalent part-time experience in investigations, auditing, data analysis, development of investigative findings, and/or preparation of audit reports.
Participation in investigative engagements or complex or specialized investigations requiring technical knowledge and expertise.
Experience translating complex quantitative analysis for nontechnical audiences.
Professional licensure or certification in a fraud-related field.

Responsibilities

Work with BSI, Audit Operations, and OSA’s IT Department to identify data and analysis requirements for reports and projects.
Proactively monitor and review electronic account and transaction data for suspicious activity and possible fraud.
Identify and document trends and patterns in Medicaid claims, Electronic Benefits Transfer (EBT) card transactions, and other transactional and operational datasets.
Analyze complex internal and external data to identify anomalies, outliers, trends, and behavior that may indicate increased risk of fraud, waste, or abuse.
Document data models and protocols for mining production databases.
Identify data sources and fields needed for reports, mapping, and computations for report metrics.
Review, investigate, and resolve irregular transactions, and identify areas requiring stronger security controls.
Apply quality assurance best practices to data mining and analysis services.
Develop, implement, and maintain change-control and testing processes for data-model modifications.
Maintain detailed records of suspicious activity, analyze trends, communicate security threats to management, and recommend loss-mitigation measures as needed.
Meet regularly with the Assistant Director regarding investigations and adhere to established timelines.
Collaborate with OSA staff at all levels to perform data analysis tasks.
Create reports using Business Intelligence tools and develop SQL queries to extract, manipulate, and summarize information.
Ensure compliance with HIPAA and other required federal and state data policies and best practices.
Address ad hoc analytics requests supporting projects.
Prepare written summaries with supporting documentation and data available to accompany analysis results.
Clearly explain what data and results indicate and how they can support project objectives.
Maintain up-to-date skills in languages, tools, and technologies.