Senior Analyst (Data Mining)

TL;DR

Senior Analyst (Data Mining): Leading the development and refinement of new reimbursement and payment integrity concepts with an accent on provider contracts, claims processing logic, and healthcare data mining. Focus on identifying systemic payment errors, designing detection methods, and partnering with technical teams to operationalize business logic.

Location: Must be based in the US

Company

A leading healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and drive down healthcare costs for health plans.

What you will do

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.
• Analyze and interpret provider contracts to ensure payments align with negotiated terms and payer rules.
• Collaborate with engineering and data science teams to translate business logic into analytical frameworks.
• Research and document emerging reimbursement patterns, coverage rules, and billing practices.
• Translate complex reimbursement scenarios into structured rules for implementation.
• Analyze claim-level data to pinpoint root causes of overpayments and recommend corrective approaches.

Requirements

• 5+ years of experience in healthcare data mining or claims editing.
• Deep understanding of provider contracts, 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.
• Strong investigative and deductive reasoning skills.
• Must be based in the US and comfortable working in a fast-paced environment.

Nice to have

• Coding or billing certifications.
• Working proficiency in SQL for data exploration and validation.
• Prior work in cross-functional R&D or innovation teams focused on healthcare payment integrity.

Culture & Benefits

• Digital-first, flexible, and trusting work environment.
• Comprehensive medical, dental, and vision insurance.
• 401(k) plan with company match.
• FSA/HSA options and solid PTO program.
• Tuition reimbursement and wellness perks.