BI Analyst

This is a fully remote position, open to applicants in Kentucky, +4 more states.

📋 Description

• Collaborate with the Special Investigations Unit (SIU), Payment Integrity, Clinical, Finance, and operational stakeholders to determine business needs and create analytical solutions.

• Design, develop, and sustain dashboards, scorecards, reports, and self-service analytics tools.

• Examine healthcare claims, provider, member, audit, and investigation data to pinpoint trends, anomalies, emerging risks, and opportunities for improvement.

• Generate regular and on-demand financial and operational reports for leadership.

• Create, implement, validate, and document statistically valid random sampling methods for provider audits, overpayment identification, error-rate measurement, and extrapolation.

• Work alongside business partners, BI Analysts, and Data Scientists to establish data requirements, enhance data quality, and operationalize advanced analytical solutions.

• Lead requirements gathering, solution design, and stakeholder review meetings.

• Ensure data accuracy, reconcile reporting outputs, and maintain metric consistency across systems and audiences.

• Present analytical findings, insights, risks, and recommendations through visualizations, presentations, and written summaries.

• Set reporting standards, documentation, governance practices, and development methodologies.

• Oversee multiple projects and priorities while communicating status, risks, dependencies, and opportunities.

⛳️ Requirements

• Bachelor's degree or advanced degree (as applicable).

• A minimum of 3 years of experience in healthcare analytics, SIU, Payment Integrity, or a related discipline.

• If lacking a degree, at least 5 years of experience in a related field.

• Strong analytical, problem-solving, and communication abilities.

• Experience in supporting SIU, Fraud, Waste & Abuse (FWA), Payment Integrity, claims auditing, or provider payment review functions.

• Understanding of healthcare claims processing, reimbursement methodologies, CPT, HCPCS, ICD-10, DRG, and provider billing practices.

• Familiarity with statistical sampling methodologies, confidence intervals, extrapolation, and audit-related analytics.

• Experience in measuring healthcare savings, recoveries, cost avoidance, and operational performance metrics.

• Proficiency with Snowflake.

• Experience in building AI agents.

• Authorization to work in the United States.

🏝️ Benefits

• Annual Incentive Bonus based on corporate goal achievement and individual performance.

• 401(k) plan with employer matching.

• Paid Time Off (PTO).

• Competitive health benefits.

• Wellness programs.

• Reasonable accommodations for applicants with disabilities.