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Jared Williams

Jared Williams

Data Science Fraud Manager

Blue Cross Blue Shield of Massachusetts

Technologies

DataCamp Course Completion

Take a look at all the courses I’ve completed on DataCamp.

Courses

Introduction to Python
Introduction to SQL
Introduction to R
Intermediate Python

My Work Experience

Where I've interned and worked during my career.

Blue Cross Blue Shield of Massachusetts | May 2023 - Present

Data Science Fraud Manager

N/A

CVS Caremark | Mar 2023 - May 2023

Senior Decision Scientist - Fraud, Waste and Abuse

N/A

Aetna, a CVS Health Company | May 2019 - Mar 2023

Sr. Analyst

- Research and ad hoc report development to identify fraud, waste and abuse schemes and trends. - Staying up do date with new and emerging fraud, waste and abuse schemes and trends through training sessions and industry resources. - Review the clinical & payment policies to determine the impact of the schemes on the business. - Create and document requirements and work with data science business partners to create business rules that use claim data to auto generate Fraud, Waste or Abuse leads for investigation. - Stay up to date with coding changes to ensure that existing business rules are being updated as well. - Analyze and present key findings to internal customers to provide recommendations based on the findings. - Create VBA macros for each business rule to create efficiency and consistency within referral process. - Utilize SAS enterprise guide create process flows which automate and generate weekly reports to be reviewed for newly flagged providers. - Utilize Power BI to present metrics through visualizations on a quarterly basis. - Conduct Excel and Power BI trainings for the Special Investigations Unit.
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Commonwealth of Massachusetts | Sep 2017 - May 2019

Data Analytic Fraud Examiner

N/A

Commonwealth of Massachusetts | Mar 2017 - Sep 2017

Fraud Examiner

- Analyzed irregularities with subjects that have allegations against them for committing public assistance fraud. - Obtained evidence that will support allegation such as if subject was on assistance at the time. - Escalated case to senior examiners if it meets the criteria of public assistance fraud. - Met regularly with Assistant Director regarding investigations. - Trained new staff on projects - Prepared reports, evidence, and correspondence concerning investigations of public assistance fraud to provide required information and makes appropriate recommendations concerning investigations. - Utilized different data warehouses for investigations.

Santander Consumer USA Inc. | Mar 2016 - Mar 2017

Fraud Specialist II

- Analyzed case details to identify methodology of each fraud scheme, assess existing preventive controls, identify control gaps, recommend and implement mitigation strategies. - Contributed to Key Performance Indicators, prevention results, and fraud loss management reports. - Maintained the case management system for tracking fraud cases and relevant information. - Monitored the performance of the rules to ensure that agreed risk levels and positive customer experience are maintained. - Examined account transactions such as check deposits to verify their validity. - Documented results of actions taken to support fraud trending and reporting. - Analyzed loss experienced based on monthly/quarterly/annual losses for trending. - Provided support to Field Investigators, senior analysts, and Loss Prevention Team Managers. - Complied with all applicable federal regulations in decision process. - Utilized Microsoft Excel and Access for Data Analysis for discovering outliers - Demonstrated proficiency of applicable systems, tools, policies and procedures, and bank regulations. - Assisted in new ways to mitigate losses.

Santander Consumer USA Inc. | Jul 2014 - Mar 2016

Fraud Specialist

- Researched and analyzed high risk transactions across all payment channels with a sense of urgency in a fast paced environment. - Identified fraud patterns and communicated observations to analysts and management. - Collaborated with internal and external customers to make decisions on transactions and perform appropriate actions required to mitigate losses. - Facilitated special projects as the lead role.

My Education

Take a look at my formal education

Master of Science - MS, Applied Data Analytics in Applied Data AnalyticsBoston University - Metropolitan College | 2023
20461 Querying Microsoft SQL Server  New Horizons Computer Learning Centers - Englewood | 2018
Bachelor of Science - BS, Criminal JusticeBridgewater State University | 2013

About Me

Jared Williams

I am a data enthusiast and always looking to learn new techniques and concepts

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