Program Integrity Director Jobs in Lynn, MA (NOW HIRING)

About the Role:

The Massachusetts Office of Medicaid (MassHealth) is seeking a highly motivated, collaborative, and experienced analytics professional to serve as a Senior Healthcare Data Analyst within the MassHealth Analytics Department. This position provides advanced analytical and technical support to MassHealth's Program Integrity (PI) team, helping safeguard public resources, strengthen program accountability, and support efforts to identify fraud, waste, and abuse (FWA). The successful candidate will analyze complex healthcare data, develop advanced analytical methodologies, evaluate provider billing and utilization patterns, and translate sophisticated analyses into actionable insights that inform program integrity activities, policy, and operations.

Reporting to the Deputy Director of Analytics, the Senior Healthcare Data Analyst will serve as a technical subject matter expert and work collaboratively with Program Integrity staff, MassHealth program teams, data warehouse staff, vendors, and other internal and external stakeholders. The position will develop and deploy advanced SQL queries and analytical data models, analyze large eligibility, enrollment, and claims datasets, identify potential overpayments and indicators of FWA, and support audits and investigations. The Senior Healthcare Data Analyst will independently manage complex analytical projects, oversee key analytical assets and code, provide guidance to junior analysts, and help ensure that data and analytical methodologies are used effectively to support MassHealth's programmatic and operational objectives.

The primary work location for this position is 1 Enterprise Drive, Quincy, Massachusetts 02171. The work schedule is Monday through Friday, 9:00 AM to 5:00 PM EST. This position follows a hybrid work model that combines in-office and remote workdays based on operational needs.

Duties and Responsibilities: (These duties are a general summary and not all-inclusive.)

• Analyze, design, and develop complex analytical data models using large healthcare datasets, including eligibility, enrollment, claims, provider, utilization, and payment data.
• Develop advanced SQL queries and analytical methodologies to identify trends, cost and utilization drivers, provider billing patterns, potential overpayments, and indicators of fraud, waste, and abuse (FWA).
• Lead complex analytical projects from initial scoping through execution, quality assurance, interpretation, and presentation of results.
• Partner with Program Integrity staff and other stakeholders to define business and analytical needs and translate findings into actionable insights that support audits, investigations, policymaking, and program operations.
• Collaborate with data warehouse and technical teams to develop data models, analytical assets, and reusable code that support effective use of data across the agency.
• Serve as a technical subject matter expert to vendors performing analytical work, including providing guidance on data use, methodologies, deliverables, and initiatives involving artificial intelligence.
• Conduct data profiling, validation, testing, and quality control to ensure the accuracy and reliability of analytical products.
• Oversee the development and maintenance of key analytical assets and provide technical guidance, training, and support to junior analysts.
• Lead and participate in cross-functional initiatives while independently managing multiple projects, priorities, and deliverables.
• Perform other duties as assigned.

Preferred Qualifications:

• Experience working with healthcare claims, eligibility, enrollment, provider, utilization, payment, or other healthcare administrative data.
• Experience supporting Program Integrity, fraud, waste, and abuse detection, payment integrity, provider auditing, claims analysis, or related healthcare oversight activities.
• Advanced proficiency in SQL and experience analyzing large and complex datasets containing millions of records.
• Experience developing analytical data models, reusable datasets, code, and other technical assets.
• Experience with data visualization and business intelligence tools such as Tableau.
• Demonstrated experience independently conducting complex analyses from development of the analytical approach through execution, quality assurance, interpretation, and presentation of results.
• Ability to translate complex analytical findings into clear, actionable information for technical and nontechnical stakeholders.
• Experience serving as a technical subject matter expert, collaborating across functional teams, and providing guidance or support to junior analysts.
• Familiarity with AI-assisted development tools, including coding copilots, AI agents, or similar technologies, and the ability to apply them effectively and responsibly within analytics workflows.
• Strong critical-thinking, problem-solving, data-validation, organizational, and communication skills, with the ability to manage multiple priorities independently.
• Knowledge of Medicaid, MassHealth, Program Integrity, or the Massachusetts healthcare industry is highly desirable.

About MassHealth:

MassHealth, the Commonwealth's Medicaid and Children's Health Insurance Program, provides comprehensive healthcare coverage to nearly two million residents, including children, families, older adults, and individuals with disabilities. Working with healthcare providers, managed care organizations, accountable care organizations, community partners, and state and federal agencies, MassHealth is committed to improving health outcomes, advancing equitable access to high-quality healthcare, and ensuring responsible stewardship of public resources.

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.

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!

An Equal Opportunity / Affirmative Action Employer.  Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.  Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements.  We encourage individuals who believe they have the skills necessary to thrive to apply for this role.