Healthcare Data Mining Analyst

Job Summary

To support healthcare payment integrity efforts, the full-time Healthcare Data Mining Analyst will analyze claims data, identify payment errors, and collaborate with technical teams to operationalize findings, all while working remotely.

Key responsibilities

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise
• Analyze provider contracts to ensure payments align with negotiated terms and methodologies
• Collaborate with engineering and data science teams to translate reimbursement logic into analytical frameworks

Required qualifications

• 2+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side
• Deep understanding of provider contracts, including rate structures and reimbursement methodologies
• Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers
• Proven ability to identify improper payment patterns and root causes
• Comfortable collaborating with technical teams to guide implementation of business logic