Forensic Data Analyst, Specialist - Remote

Overview

The Forensic Data Analyst, Specialist plays a pivotal role in advancing our products and services by shaping solution design and supporting strategic decision-making.

In Short

• Collaborates closely with engineers, clinical experts, payment professionals, and business operations leaders to develop reporting and analyze large-scale healthcare claims and clinical datasets.
• Generates new analytic content aimed at ensuring claims are paid accurately.
• Leverages advanced coding, analytic reporting, and predictive modeling to uncover actionable insights that drive innovation and improve outcomes across the organization.
• Work cross functionally to identify opportunities for leveraging company data to drive business solutions.
• Mine and analyze data from healthcare claim databases to drive optimization and improvement of product development, sales, marketing techniques, and business strategies.
• Design and develop business intelligence reporting suite for internal and external consumption.
• Author new analytic content aimed at ensuring health plans pay accurate and reasonable amounts for claims submitted on behalf of their members.
• Partner with Data Science and Engineering to develop custom complex SQL queries and algorithms to apply to data sets.
• Partner with Data Science and Engineering to create predictive modeling to support business reporting and decision making.
• Develop processes to monitor and analyze model performance and accuracy of results.

Requirements

• Minimum of 10 years experience manipulating data sets and building statistical models through SQL, and more advanced technologies.
• Minimum of 7 years experience with healthcare data and standard UB/HCFA claim fields.
• Experience using and developing in enterprise level business intelligence tools (e.g. PowerBI, Sigma, Tableau, Domo).
• Bachelor's degree in business or healthcare/related field (preferred).
• Excellent written and verbal communication skills for coordinating across teams and with customers.
• Experience partnering with Data Science teams to ideate algorithms and models, using statistical computer languages (SQL, Python, R) to manipulate data and generate insights from large data sets.
• Experience working in project management tools (Jira, Confluence) employing proficiency in time management abilities.
• Strong problem-solving skills with an emphasis on product development.
• Drive to learn and master new technologies and techniques.
• Experience building, and delivering, compelling presentations in PowerPoint (or similar).
• Experience across multiple Payment Integrity product areas (e.g. Edits, Data Mining, Coordination of Benefits, SIU, etc).

Benefits

• The US base salary range for this full-time position is: $146,910.00 - $220,366.00.
• The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate’s relevant experience, education, and work location.
• Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation.