About the Role :

Massachusetts' Office of Medicaid (MassHealth) is looking for an exceptional Senior Healthcare Data Analyst to join the Analytics Department. The MassHealth Analytics team produces quantitative and qualitative analyses to inform business decisions at MassHealth. The selected candidate will report to the Deputy Director of Analytics and will collaborate closely with other MassHealth units to identify and answer key analytic questions to inform agency policy and operations.

The Senior Healthcare Data Analyst will work closely with MassHealth's Program Integrity (PI) team, supporting efforts to safeguard public resources and uphold program accountability. This role will sit at the intersection of data, compliance, and cross-agency collaboration with a focus on supporting fraud, waste, and abuse (FWA) investigations and external audits. This position requires expertise in developing and deploying advanced SQL queries, data modeling, and predictive analytics using industry-leading visualization and statistical tools. The incumbent will design comprehensive analytical frameworks to identify complex cost and utilization drivers, develop algorithmic approaches to detect anomalies and indicators of potential FWA, and translate sophisticated analytic methodologies into actionable insights for stakeholders at all organizational levels. The Senior Analyst will serve as a technical SME to vendors to ensure they are appropriately using data to identify FWA. The Senior Analyst may also be required to serve as a subject matter expert (SME) to cross-functional agency-wide initiatives and will be expected to work on multiple concurrent projects and complete deliverables independently.

The primary work location for this role will be at 1 Enterprise Drive, Quincy, Massachusetts 02171. The work schedule for this position is Monday through Friday, 9:00AM to 5:00PM EST. This position would be expected to follow a hybrid model of reporting to work that combines in-office workdays and work from home days as needed.

Responsibilities :
• Analyze, design, and develop complex analytical data models.
• Manage the delivery and reporting required by requestors. This involves working with stakeholders to define specifications based on input from program staff and testing these specifications on our data to ensure validity, working with complex eligibility, enrollment, and claims data to get answers to these questions, and then present results in a clear, concise, and accurate way that helps the agency both respond to outside inquiries and inform policymaking. This also involves managing timeframes and communicating with internal and external staff on deliverable expectations.
• Collaborate with data warehouse staff to develop data models to aid in the use of data across the agency to inform key business decisions.
• Lead analyses assessing provider billing patterns to produce audit targets and/or identify overpayments.
• Serve as a technical SME providing input to vendor(s) integrating AI into program integrity operations.
• Provide technical SME input to current vendors performing analytic work.
• Assist in identifying and prioritizing business information needs and defining business benefit of data warehousing. Perform data analysis, profiling, and testing.
• Help support the team by:

o Overseeing the production and maintenance of key analytic assets (data objects) for use by more junior team members in their own work.

o Overseeing the production and maintenance of key analytic code as required to enable effective analytical work.

o Providing training and support of junior analysts as required.
• Perform other duties as assigned .

Preferred Qualifications :
• Familiarity with Health Care data and analytic best practices.
• Familiarity with program integrity efforts and industry practices.
• Experience working with Large Datasets (many millions of records).
• Expertise in SQL and other programming languages.
• Experience with Data Visualization software such as Tableau.
• Experience conducting independent analysis from drafting analytic plans to execution to presenting results.
• Demonstrated ability to interact with stakeholders and present analyses and help interpret results.
• Ability to lead and participate in cross-functional teams to achieve goals.
• Ability to lead and guide more junior staff in analytical and reporting work.
• Strong Critical thinking skills and an attention to detail.
• Ability to problem-solve and work independently.
• Knowledge of the Massachusetts health care industry and market dynamics is a plus.
• Strong QC skills and an attention to detail.
• Ability to prioritize numerous tasks, under time constraints and changing priorities.

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori .

Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

ADA Reasonable Accommodation: If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests

For questions, please contact the Office of Human Resources at 1-800-510-4122 and select option #4.

Qualifications:
First consideration will be given to those applicants that apply within the first 14 days.

Minimum Entrance Requirements:

Applicants must have (A) at least three (3) years of full-time or equivalent part-time professional or practical experience in the field of information technology data analytics, or (B) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. An Associate's degree in a related field may substitute for one (1) year of the required experience.

II. A Bachelor's degree or higher in a related field may substitute for two (2) years of the required experience.

III. A Master's degree or higher in a related field may substitute for the required experience .

Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!