Data Analytics Fraud Examiner

Job Description

Job Description

SALARY RANGE (Grade 11) CSA926: $61,466.46/yr. -- $92,200.45/yr.  (Commensurate with experience)

  This position will be based out of the Boston, Lawrence, Quincy, Brockton, Marlboro, or Chicopee OSA offices.  Please indicate your geographical preference in office location when applying per the application instructions below.

GENERAL STATEMENT OF DUTIES:

The incumbent is responsible for investigating fraudulent claims, transactions, and or complaints of unlawful receipt of funds within the public assistance programs in the Commonwealth of Massachusetts.  The incumbent also is responsible for collecting, understanding, and analyzing information using a variety of tools, databases and data analysis techniques to detect fraud. This includes analyzing trends in data, patterns of behavior, accurately quantifying and aggregating risk and succinctly communicating items of interest to management.

The Data Analytics Fraud Examiner must also present conclusions in reports and answer questions about the data and findings, in order that the Director and other members of the Bureau of Special Investigations (BSI) may better understand information obtained.

SUPERVISION RECEIVED:

Work under the direct supervision of the Assistant Director overseeing the BSI Data Analytics team. 

SUPERVISION EXERCISED:

None.

DUTIES AND 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, as well as a variety of other transactional and operational data sets.
• Analyze complex internal / external data and identify anomalies, outliers, trends and other behaviors that may indicate an increased risk for fraud, waste or abuse.
• Document data models and protocols for mining production databases.
• Identify sources of data and data fields for reports, mapping, and computations required to create metrics for reports.
• Review, investigate, and resolve irregular transactions and identify areas requiring increased security controls to protect an organization and its end users from future incidents of fraud.
• Apply quality assurance best practices for data mining/analysis services.
• Develop, implement, and maintain change control and testing processes for modifications to data models.
• Keep detailed records of suspicious activity, analyze trends, communicate security threats to management, and provide recommendations for loss mitigation as needed.
• Meet regularly with Assistant Director regarding investigations and adhere to timelines as determined by the Assistant Director.
• Collaborate with staff at all levels throughout the OSA as necessary to perform data analysis tasks.
• Experience creating reports using Business Intelligence tools.
• Develop SQL queries to extract, manipulate, and summarize information.
• Ensure compliance with HIPAA and other Federal and State required data policies/best practices.
• Address ad-hoc analytics requests to support projects.
• Prepare written summaries with supporting documentation/data readily available to accompany results of analyses.
• Explain clearly what the data and results indicate and how it can be utilized to support the project objectives.
• Maintain up-to-date skills of new languages, tools and technologies.

MINIMUM QUALIFICATIONS:

• Bachelor's degree in criminal justice, public policy, public administration, or a related field.
• Ability to understand complex requirements and present data in an accurate, understandable and relevant manner.
• Demonstrated ability in writing T-SQL and using SSMS or other query tools.
• Demonstrated ability in data analysis and visualization tools (Qlik, ArcGIS, Tableau).
• Ability to work with large datasets.
• Knowledge of data analysis techniques.
• Advanced Excel capabilities and related data manipulation required.
• Knowledge of data analytics, data modeling and data visualization.
• Ability to research and gather relevant information from trusted and accurate sources to prepare internal analysis and final reports.
• Demonstrated ability to communicate effectively, both orally and in writing.
• Proven analytical and problem-solving abilities.
• Highly self-motivated and directed.
• Ability to effectively manage workload and adjust to changing priorities.
• Strong intermediate or advanced level skills with Microsoft Access.
• Experience creating reports using Business Intelligence tools
• A strong understanding of data warehousing concepts and relational databases.

PREFERRED QUALIFICATIONS :

Demonstrated experience and expertise in the following areas will also be important considerations:

• At least three (3) years' experience in investigations, research, analytics or related field.
• Ideal candidate will have 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.)
• A master's degree in criminal justice, public policy, public administration or a related field, or substantial professional experience 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.

The Office of the State Auditor is committed to providing equal employment opportunities.  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.