Healthcare Claims Data Analyst

Job Description:

• Develop fraud, waste, and abuse analytics from concept to finished product for the Healthcare Fraud Prevention Partnership
• Work against a multi-billion-record claims warehouse assembled from public and private healthcare payers
• Translate partner and client requests into specific analytic questions
• Determine what can and cannot be answered with available data and raise limitations early
• Build analytic logic in SQL and Python against billions of claim records
• Test and refine analytics with Fraud, Waste, and Abuse Subject Matter Experts
• Distinguish genuine aberrancy from patterns explained by clinical practice, coverage policy, or claim edits
• Document methodology, assumptions, and data lineage for reproducibility
• Document findings and present results to internal stakeholders
• Participate in partner discussions to clarify analytic requirements
• Manage several concurrent requests against firm deadlines in a partner- and client-driven queue
• Work with Data Scientists, Business Intelligence Developers, and FWA Subject Matter Experts

Requirements:

• Bachelor's degree in a quantitative or health-related field, or equivalent hands-on experience
• 4+ years writing SQL against large relational data, including CTEs, window functions, and multi-table joins at scale
• Performance awareness sufficient to understand why a query is slow
• Working proficiency in Python for data analysis, producing clean and reproducible analysis code
• Ability to turn ambiguous requests into defined analytic questions
• Ability to recognize when a question cannot be answered with available data
• Experience documenting analytic work so another person can reproduce it
• Ability to learn an unfamiliar data domain quickly
• Ability to explain analytic results clearly in writing and conversation to non-analyst audiences
• Accuracy, attention to detail, and organizational discipline to manage concurrent requests
• US citizen or Permanent Resident
• Must be able to obtain/maintain Public Trust
• Work visa sponsorship will not be provided
• Candidates must reside in the United States
• Desired: healthcare claims data and coding systems experience, FWA/program/payment integrity or utilization review exposure, Snowflake/SnowSQL or comparable cloud data warehouse, Git and collaborative code review, payer coverage policy and claim edits, Tableau or other data visualization software

Benefits:

• Medical plan options, including some with Health Savings Accounts
• Dental plan options
• Vision plan
• 401(k) plan with pre-tax and post-tax contributions and company match
• Flexible work schedule and full flex work weeks where possible
• Paid time off, including vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave
• Typically 15 days of paid leave per calendar year
• 10 paid holidays per year
• Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees
• Short- and long-term disability benefits
• Life insurance
• Accidental death and dismemberment insurance
• Personal accident insurance
• Critical illness insurance
• Business travel and accident insurance
• Collaborative inter-disciplinary environment
• Fully remote work arrangement