Health Insurance Built Around Me
Payment Integrity Analyst – Data Mining, Savings Reporting
Location
New York + 1 moreAll locations: New York | Vermont
Posted
75 days ago
Salary
$69.4K - $92.3K / year
Seniority
Senior
Job Description
Payment Integrity Analyst – Data Mining, Savings Reporting
MVP Health Care
• Use advanced data mining and analytical techniques to identify improper payments, uncover cost savings opportunities, and support accurate, compliant claims payment across our health plan and report on financial trends • Build, maintain, and enhance data pipelines that support payment integrity and savings analysis initiatives • Analyze healthcare claims data to identify improper payments, wasteful spend, and cost reduction opportunities • Perform deep-dive statistical analysis, predictive modeling, and experimental design to inform business strategies and operational improvement • Conduct detailed reviews of claims history, provider files, and medical reviews to identify billing irregularities and financial trends • Collaborate with cross-functional partners to quantify and report savings generated by payment integrity activities • Develop and deliver actionable insights and evidence-backed referrals that reduce health insurance costs • Prepare and present savings reports, trending analyses, and recommendations to stakeholders • Identify and resolve data quality issues, including discrepancies or missing data • Ensure all analysis and reporting complies with regulatory requirements and internal policies
Job Requirements
- Bachelor’s degree in healthcare administration, business, data science, or a related field or 5 years of equivalent experience in healthcare billing, claims adjudication, payment integrity operations, or healthcare reimbursement analytics
- 3+ years of experience working with healthcare data analysis, group health business, or provider practice preferred
- Strong experience analyzing large healthcare datasets using SQL or modern data tools (e.g., Snowflake, dbt, Looker, Python)
- Experience with claims, payment integrity, or Medical Economics, especially in Medicare Advantage and/or New York Medicaid is a plus
- Advanced analytical skills with the ability to interpret complex data and derive meaningful insights
- Detail-oriented with a high level of precision and accuracy in handling critical data
- Strong critical thinking, problem-solving, and communication skills (oral and written)
- Ability to work independently and collaboratively in a fast-paced, high-growth environment
- Skilled at preparing clear, actionable documentation and executive-level summaries
- Intermediate knowledge of local, state, and federal laws and regulations pertaining to health insurance is a plus.
Benefits
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
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