Senior Healthcare Data Analyst

Description

The company is a healthcare intelligence firm working across the full payment process. It serves more than 85 health plans, many of them among the twenty largest, covering over 270 million lives with a configurable, AI-powered platform and specialist expertise.

The team is rebuilding how payers audit and pay claims at scale, using AI. This senior role sits between healthcare domain knowledge and data engineering: you turn raw claims feeds into trusted canonical models, surface payment integrity findings, and become the in-house authority on how claims move through adjudication. It suits someone who knows healthcare data well and wants to apply modern AI tools to work faster and build better.

Responsibilities

• Map raw medical and institutional claims (837 EDI, UB-04, CMS-1500) into the company's canonical models, applying ICD-10-CM/PCS, CPT and HCPCS coding standards.
• Learn the platform in depth, from ingestion through adjudication, so your analysis stays accurate, traceable and aligned with business needs.
• Find and resolve defects that affect accuracy or completeness, checking pipeline output end to end with SQL and Spark SQL.
• Spot overpayment patterns, coordination of benefits issues and billing edit opportunities using payer policy, CMS rules and provider reimbursement methods.
• Use LLMs to speed up analysis, identify manual work worth automating, and help build AI-assisted pipelines.
• Support onboarding of new client data feeds with minimal disruption, documenting transformation logic and lineage.
• Work with data engineers, data scientists, clinicians and product managers to turn complex healthcare requirements into scalable data solutions and support advanced analytics and ML.
• Act as the go-to expert on claim coding, adjudication rules and payer policy, mentoring analysts and engineers and advising stakeholders on risk, trends and business impact.

Requirements

• A bachelor's degree in business, computer science, health informatics or a related field.
• 5+ years working directly with healthcare claims data such as 837 EDI, encounter data and medical billing, ideally gained at a payer, a payment integrity vendor or an analytics company focused on healthcare.
• Thorough knowledge of professional and institutional claim types, coding systems (ICD-10-CM/PCS, CPT, HCPCS) and standard claim forms (UB-04, CMS-1500).
• Hands-on payment integrity work, such as overpayment detection, COB, billing edits or claim edit logic.
• Working familiarity with CMS rules and commercial payer guidelines as they apply to adjudication and payment policy.
• Advanced SQL skills, with experience writing complex analytical queries against large datasets.
• A sound grasp of data modeling concepts and analytics best practices.
• A clear communicator who can explain healthcare processes and payment logic to health plan clients, clinicians and non-technical colleagues.
• Self-directed and accountable, able to juggle several initiatives at once.
• Preferred: working knowledge of provider reimbursement methods, including MS-DRG/APR-DRG pricing, fee schedules, per diem and capitation.
• Preferred: proficiency in Spark SQL or a similar distributed query engine for large data environments.
• Preferred: experience with ETL/ELT pipeline work or close collaboration with data engineers on pipeline design.
• Preferred: exposure to value-based care or risk adjustment, such as HCC coding and RADV.

Conditions

Remote role open to candidates anywhere in the US; the company is digital-first.

Base salary range is $140,000 to $170,000, plus private equity.

Pay within the range depends on factors such as years and depth of experience, specific skills and certifications. Recruiters may tell you if you qualify for a different role or range.

Benefits

• Full medical, dental and vision coverage for employees and their families.
• Unlimited FTO.
• Equity, plus a 401(k) with employer match.
• Total pay also includes equity, healthcare, flexible time off and other benefits and perks.
• A flexible, trust-based setting where you can do your best work.