Use advanced data mining and analytical techniques to identify improper payments, uncover cost savings opportunities, and support accurate, compliant claims payment across our health plan and report on financial trends
Build, maintain, and enhance data pipelines that support payment integrity and savings analysis initiatives
Analyze healthcare claims data to identify improper payments, wasteful spend, and cost reduction opportunities
Perform deep-dive statistical analysis, predictive modeling, and experimental design to inform business strategies and operational improvement
Conduct detailed reviews of claims history, provider files, and medical reviews to identify billing irregularities and financial trends
Collaborate with cross-functional partners to quantify and report savings generated by payment integrity activities
Develop and deliver actionable insights and evidence-backed referrals that reduce health insurance costs
Prepare and present savings reports, trending analyses, and recommendations to stakeholders
Identify and resolve data quality issues, including discrepancies or missing data
Ensure all analysis and reporting complies with regulatory requirements and internal policies

Requirements

Bachelor’s degree in healthcare administration, business, data science, or a related field or 5 years of equivalent experience in healthcare billing, claims adjudication, payment integrity operations, or healthcare reimbursement analytics
3+ years of experience working with healthcare data analysis, group health business, or provider practice preferred
Strong experience analyzing large healthcare datasets using SQL or modern data tools (e.g., Snowflake, dbt, Looker, Python)
Experience with claims, payment integrity, or Medical Economics, especially in Medicare Advantage and/or New York Medicaid is a plus
Advanced analytical skills with the ability to interpret complex data and derive meaningful insights
Detail-oriented with a high level of precision and accuracy in handling critical data
Strong critical thinking, problem-solving, and communication skills (oral and written)
Ability to work independently and collaboratively in a fast-paced, high-growth environment
Skilled at preparing clear, actionable documentation and executive-level summaries
Intermediate knowledge of local, state, and federal laws and regulations pertaining to health insurance is a plus.

Benefits

Growth opportunities to uplevel your career
A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
Competitive compensation and comprehensive benefits focused on well-being
An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

data mininganalytical techniquesstatistical analysispredictive modelingexperimental designSQLSnowflakedbtLookerPython

Soft Skills

critical thinkingproblem-solvingcommunicationdetail-orientedcollaborativeindependent workorganizational skillspresentation skillsanalytical skillsaccuracy

Certifications

Bachelor’s degree in healthcare administrationBachelor’s degree in businessBachelor’s degree in data science