You will join the Payment Integrity team and transform complex healthcare claims, provider, operational, and financial data into actionable insights that improve business performance and drive operational excellence. You will dig into large datasets to uncover patterns, connect the dots across multiple sources, identify process inefficiencies, and recommend corrective actions. You will build dashboards, scorecards, and automated reports, and partner closely with engineering, operations, audit, finance, product, and leadership teams to support strategic decision-making through advanced analytics, forecasting, and performance measurement. This role suits a self-motivated professional who thrives in a fast-paced, high-growth environment and enjoys solving complex business problems through data.
Responsibilities
- Analyze large healthcare datasets including medical claims, audit outcomes, provider data, reimbursements, appeals, invoices, outreach activity, and operational performance metrics to identify trends, anomalies, and business opportunities
- Build analytics to support provider outreach effectiveness, response tracking, follow-up performance, and provider abrasion control initiatives
- Monitor and improve end-to-end audit lifecycle SLAs, turnaround time, queue aging, throughput, and productivity metrics
- Perform invoice reconciliation by validating recoveries, fees, payments, billing outputs, and financial reporting accuracy
- Build and maintain dashboards, scorecards, and KPI reporting using Power BI, Tableau, Looker, or similar tools
- Develop automated daily, weekly, and monthly reports for operational, financial, and executive stakeholders
- Generate ad hoc reports and business analysis based on evolving operational priorities
- Ensure all reports, dashboards, and published metrics are accurate, reconciled, and aligned across systems
- Create profiling reports for auditors, providers, clients, claims inventory, productivity, and recoveries and monitor for changes, trends, and performance drift
- Detect operational drift, unusual patterns, leakage points, and inefficiencies and recommend corrective actions
- Uncover hidden patterns in data and connect insights across multiple sources to support business decisions
- Perform root cause analysis on missed recoveries, SLA breaches, provider abrasion, operational delays, and reporting variances
- Use advanced analytics and forecasting to support staffing models, productivity planning, and business growth initiatives
- Create and optimize complex queries, data models, and automated workflows using SQL and Python
- Partner with operations, audit, finance, product, and leadership teams to support strategic decision-making
- Maintain data governance standards and adhere to HIPAA and company privacy policies
Requirements
- 3+ years of experience in Data Analytics, Business Intelligence preferably healthcare Claims Analytics, or Payment Integrity Analytics
- Advanced expertise in SQL including complex joins, CTEs, stored procedures, optimization, and large dataset handling
- Strong hands-on expertise in Python for automation, reporting workflows, data transformation, and advanced analytics
- Advanced proficiency in Microsoft Excel and Google Sheets including pivots, lookups, formulas, data validation, and dashboards
- Experience with BI/reporting tools such as Power BI, Tableau
- Proven ability to ensure reporting accuracy, reconcile numbers, and maintain trust in published metrics
- Strong analytical mindset with ability to uncover patterns in data and connect the dots across multiple sources
- High attention to detail with a strong focus on data quality and accuracy
- Experience creating automated reporting suites, KPI dashboards, and executive scorecards
- Experience monitoring productivity, SLA, TAT, queue health, financial metrics, and operational performance
- Strong cross-functional collaboration skills
- Excellent communication skills with ability to translate complex findings into clear business recommendations
- Strong prioritization, ownership mindset, and problem-solving capability
- Bachelor's degree in Analytics, Statistics, Computer Science, Finance, Healthcare Administration, or related field