Healthcare Claims Data Analyst

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

📋 Description

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

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

• Convert partner and client requests into targeted analytic queries.

• Develop comprehensive analytics using SQL and Python to analyze billions of claims records.

• Test and enhance analytics in collaboration with Fraud, Waste, and Abuse Subject Matter Experts.

• Differentiate between genuine billing anomalies and legitimate clinical practices, coverage policies, and claim-edit patterns.

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

• Present findings to internal stakeholders and engage in discussions with partners.

• Handle multiple concurrent requests while adhering to tight deadlines in a demand-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.

• Proficient in SQL, including CTEs, window functions, and multi-table joins at scale.

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

• Working knowledge of Python for data analysis, including libraries like pandas or similar.

• Capability to produce clean and reproducible analysis code.

• Skill in translating vague requests into specific analytic inquiries.

• Ability to identify when a question cannot be addressed with the available data.

• Experience in documenting analytic processes so they can be replicated by others.

• Quick learner with the ability to adapt to an unfamiliar data domain.

• Proficiency in articulating analytic results clearly, both in writing and verbally, to non-analysts.

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

• Must be a US citizen or Permanent Resident.

• Must be eligible to obtain and maintain a Public Trust clearance.

• Work visa sponsorship will not be available.

• Preferred: experience with healthcare claims data and coding systems, exposure to FWA or program integrity, familiarity with Snowflake/SnowSQL or similar cloud data warehouses, Git and collaborative code review, payer coverage policy and claim edits, and proficiency with Tableau or other data visualization tools.

🏝️ Benefits

• Competitive salary and benefits package.

• Flexible work schedule.

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

• Various dental plan selections.

• Multiple vision plan options.

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

• Full flexibility for work weeks whenever possible.

• Vacation, sick leave, and personal time off.

• Paid holidays.

• Paid parental leave.

• Military leave provisions.

• Bereavement leave.

• Jury duty leave.

• Typically, 15 days of paid leave each calendar year.

• An additional 10 paid holidays throughout the year.

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

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• Fully remote work opportunities.

• Collaborative interdisciplinary work environment.