DATA ANALYTICS SPECIALIST - SR - 74522

Executive Service

This position is designated as a hybrid position with office presence as needed.

For more information, visit the link below:
www.tbijobs.com

Background Check:

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

The TBI Medicaid Fraud Control Division is one of the eight major divisions within TBI and consists of over 64 employees made up of special agents, attorneys, auditors, analysts and support staff. In general, Medicaid Fraud Control Units (MFCUs), established under 42C.F.R. *1007, investigate and prosecute Medicaid provider fraud as well as patient abuse and neglect of residents in institutional and non-institutional settings. While most cases involve criminal fraud prosecutions, MFCUs increasingly pursue civil actions under the False Claims Act and state equivalents recovering tens of millions in Tennessee alone. MFCUs also address physical, sexual, and financial abuse and neglect of Medicaid recipients in any care setting.

How you make a difference in this role:

A data analytic specialist plays a vital role in combating fraud and patient abuse by using advanced data mining techniques to uncover hidden patterns in claims, billing, and patient records. Through algorithms and predictive models, they can detect anomalies such as excessive service volumes, duplicate claims, or suspicious prescribing behaviors. These insights help the Medicaid Fraud Control Unit (MFCU) prioritize investigations, allocate resources efficiently, and identify high-risk providers before harm occurs. By transforming raw data into actionable intelligence, analysts not only strengthen fraud detection through pro-active data mining but also enhance compliance and protect patient safety.

Job Overview:

The Data Analytic Specialist supports the Medicaid Fraud Control Division by working closely with special agents, attorneys, and support staff to detect healthcare fraud and patient abuse. This role leverages data mining, advanced analytics, and reporting to identify suspicious patterns, provide actionable insights, and assist in investigations that protect program integrity and patient safety.

Key Responsibilities:

Data Mining & Analysis:

• Extract, clean, and analyze large datasets from Medicaid claims, provider records, and other sources to identify anomalies and trends indicative of fraud or abuse.
• Develop predictive models and algorithms to detect high-risk providers and fraudulent billing practices.

Data Interpretation & Investigative Support:

• Translate complex data findings into actionable intelligence for special agents and attorneys.
• Collaborate with investigative teams to prioritize cases and support evidence development for criminal and civil prosecutions.

Reporting & Visualization:

• Create clear, concise reports and dashboards to communicate findings to internal teams and leadership.
• Present data insights in formats that support legal proceedings and investigations.

Data Collection & Management:

• Ensure data integrity, accuracy, and compliance with federal and state regulations.
• Maintain secure databases and documentation for ongoing investigations and audits.

Minimum Qualifications:

a Bachelor's degree in a quantitative or related discipline AND 2 or more years of relevant professional work experience. OR A Master's degree in a quantitative or related discipline. Some positions may require a Master's degree in addition to 2 or more years of relevant professional work experience. OR 6 or more years of relevant professional work experience. Preferred qualifications: Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or an equivalent credential, combined with prior experience in custom data analysis for investigative work and data mining techniques.

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.