Healthcare Claims Data Analyst

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

📋 Description

• Assist in anti-fraud initiatives for the Centers for Medicare and Medicaid Services.

• Create analytics for fraud, waste, and abuse from inception to completion at the Trusted Third Party.

• Analyze a multi-billion-record claims database compiled from both public and private healthcare payers.

• Convert requests from partners and clients into specific analytical inquiries.

• Identify what questions can be answered with the available data and communicate limitations early on.

• Develop end-to-end FWA analytics using SQL and Python on billions of claim records.

• Collaborate with FWA Subject Matter Experts to test and refine analytics.

• Distinguish between genuine anomalies and patterns arising from legitimate clinical practices, coverage policies, or claim edits.

• Document methodologies, assumptions, and data lineage to ensure reproducibility and integration into the analytic suite.

• Record findings and present results to internal stakeholders.

• Engage in discussions with partners to clarify analytical requirements.

• Manage multiple concurrent requests with firm deadlines driven by partner and client demand.

• Collaborate with Data Scientists, Business Intelligence Developers, and FWA Subject Matter Experts in a fully remote, multidisciplinary team.

⛳️ Requirements

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

• Over 4 years of experience writing SQL against large relational databases, including CTEs, window functions, and extensive multi-table joins.

• Awareness of performance issues to identify reasons for slow queries.

• Proficient in Python for data analysis, with the ability to produce clean and reproducible analysis code.

• Skill in transforming ambiguous requests into clearly defined analytical questions.

• Experience in documenting analytical work to enable others to replicate it.

• Ability to quickly familiarize oneself with unfamiliar data domains.

• Competence in clearly communicating analytical results to non-analytical audiences.

• Strong accuracy, attention to detail, and organizational skills.

• Must be a US citizen or Permanent Resident.

• Ability to obtain and maintain Public Trust clearance.

• Work visa sponsorship is not available.

• Preferred: experience with healthcare claims data and coding systems such as ICD-10, CPT, HCPCS, and DRG.

• Preferred: familiarity with fraud, waste and abuse, program integrity, payment integrity, or utilization review.

• Preferred: experience with Snowflake and SnowSQL or similar cloud data warehouse technologies.

• Preferred: familiarity with Git and collaborative code review practices.

• Preferred: understanding of payer coverage policies and claim edits such as NCCI.

• Preferred: experience with Tableau or other data visualization tools.

🏝️ Benefits

• Competitive salary and benefits package.

• Flexible working hours.

• Options for medical plans, some featuring Health Savings Accounts.

• Choices for dental plan coverage.

• Vision plan options available.

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

• Flexibility for full work weeks where applicable.

• Paid time off policies that include vacation, sick leave, personal days, holidays, parental leave, military leave, bereavement leave, and jury duty leave.

• Typically 15 days of paid leave annually.

• 10 paid holidays each year.

• Eligibility for up to 160 hours of paid family leave within a rolling 12-month period for qualified employees.

• Short- and long-term disability insurance.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.