Healthcare Claims Data Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Create analytics for fraud, waste, and abuse from initial concept to final product for the Healthcare Fraud Prevention Partnership.

• Work with a claims warehouse containing billions of records sourced from both public and private healthcare payers.

• Convert requests from partners and clients into precise analytic inquiries.

• Assess what can be addressed with the available data and identify limitations promptly.

• Develop analytic logic using SQL and Python to analyze billions of claim records.

• Collaborate with Subject Matter Experts in Fraud, Waste, and Abuse to test and refine analytics.

• Differentiate between genuine anomalies and patterns that can be explained by clinical practices, coverage policies, or claim edits.

• Document methodologies, assumptions, and data lineage to ensure reproducibility.

• Record findings and present results to internal stakeholders.

• Engage in partner discussions to clarify analytic requirements.

• Handle multiple concurrent requests within strict deadlines in a partner- and client-driven environment.

• Collaborate with Data Scientists, Business Intelligence Developers, and FWA Subject Matter Experts.

⛳️ Requirements

• Bachelor's degree in a quantitative or health-related discipline, or equivalent practical experience.

• Over 4 years of experience writing SQL for large relational datasets, including CTEs, window functions, and multi-table joins at scale.

• Strong performance awareness to understand the reasons behind slow queries.

• Proficient in Python for data analysis, producing clean and reproducible analysis code.

• Ability to transform vague requests into well-defined analytic questions.

• Capability to recognize when a question cannot be answered with existing data.

• Experience in documenting analytic processes for reproducibility by others.

• Quick learner in unfamiliar data domains.

• Strong communication skills to explain analytic results clearly to non-analyst audiences in both written and verbal formats.

• Attention to detail, accuracy, and organizational skills to manage multiple concurrent requests.

• Must be a US citizen or Permanent Resident.

• Ability to obtain and maintain Public Trust clearance.

• Work visa sponsorship is not available.

• Candidates must be residing in the United States.

• Preferred experience: healthcare claims data and coding systems, exposure to FWA/program/payment integrity or utilization review, familiarity with Snowflake/SnowSQL or similar cloud data warehousing, Git and collaborative code reviews, knowledge of payer coverage policies and claim edits, proficiency in Tableau or other data visualization tools.

🏝️ Benefits

• Options for medical plans, including those with Health Savings Accounts.

• Dental plan options available.

• Vision plan options provided.

• 401(k) plan featuring pre-tax and post-tax contributions with company matching.

• Flexible work schedules and full flexibility for work weeks when possible.

• Paid time off that includes vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave.

• Generally, 15 days of paid leave per calendar year.

• 10 paid holidays annually.

• Up to 160 hours of paid family leave available in a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits offered.

• Life insurance coverage provided.

• Accidental death and dismemberment insurance included.

• Personal accident insurance available.

• Critical illness insurance provided.

• Business travel and accident insurance included.

• Collaborative interdisciplinary work environment.

• Fully remote work arrangement.