Senior Data Mining Analyst

Job Summary

To support a specialist healthcare analytics team, the contract Senior Data Mining and Payment Integrity Analyst will develop data mining solutions to enhance payment accuracy and reduce improper healthcare spending while working remotely.

Key responsibilities

• Develop and implement data mining concepts to identify provider overpayments across various claims
• Research healthcare regulations and design payment integrity algorithms based on reimbursement policies and provider contracts
• Collaborate with cross-functional teams to enhance audit solutions and validate analytical outputs

Required qualifications

• Strong experience in healthcare payment integrity, analytics, or data mining
• Demonstrated expertise in analyzing medical, dental, or pharmacy claims data
• Ability to apply healthcare reimbursement policies and industry standards to claims analysis
• Experience in reviewing and validating claims data within auditing environments
• Skilled at translating complex regulatory requirements into analytical solutions