Claims Analytics

Claims Analytics Data Jobs

4 jobs found

Today

Sr Data Analyst, Healthcare Claims Audit and Compliance

Healthfirst New York, NY

New York, NY

Today

$83k - $120k/yr Full time Senior Alteryx Amazon Web Services

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Job Description

Support healthcare claims audit and compliance initiatives by turning claims and configuration data into risk insights, monitoring, and reporting.

Responsibilities

Analyze complex healthcare datasets to surface trends, anomalies, control gaps, and possible compliance or operational risks
Back Internal Audit, Compliance, and Claims Configuration Audit activities using data analysis, audit testing, monitoring, and reporting
Build advanced analytical queries in SQL, SAS, or other tools to extract, validate, and analyze data from multiple sources
Assess data quality and standardize data structures to enable consistent reporting and analysis
Create and maintain dashboards, scorecards, reports, and monitoring tools with actionable insights for leadership and business stakeholders
Communicate findings, methods, and recommendations to both technical and non-technical audiences
Assist in validating claims configuration changes, business rules, and operational controls
Document analytical processes, data issues, methodologies, and business requirements
Collaborate with Internal Audit, Compliance, Claims Operations, Configuration, IT, and other business partners
Identify opportunities to improve processes, controls, and reporting through intellectual curiosity
Perform additional duties as assigned

Requirements

Bachelor’s degree from an accredited institution or equivalent work experience
3+ years of equivalent experience
Proficiency in scripting and programming
Experience with MS Office suite, including Microsoft Access, Excel, and Word
Expertise using data analysis and query tools such as SQL
Experience with Alteryx, Tableau, Amazon Redshift, or similar analytics tools/platforms
Applied statistics skills including distributions, statistical testing, regression, and related methods
Ability to successfully run queries from a data warehouse
Expertise innovating and implementing audit techniques
Excellent communication skills
Strong time management to prioritize work and complete assignments by deadlines
Experience communicating technical information in written and verbal formats to multiple levels of technical and non-technical staff
Experience managing a heavy workload in a fast-paced environment

Technologies

SQL, SAS
MS Office suite, Microsoft Access, Excel, Word
Alteryx, Tableau, Amazon Redshift, Python, R
AWS: AWS, Glue, Sage Maker
JavaScript, D3.js
Hadoop, MapReduce
AWS Kinesis

Benefits

Medical, dental, and vision coverage
Incentive and recognition programs
Life insurance
401k contributions (all benefits are subject to eligibility requirements)

Preferred Qualifications

Master’s degree from an accredited institution
Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
Experience with analytical programming techniques such as Python and R
Experience with AWS and analytical solutions available on the platform (Redshift, Glue, Sage Maker, etc.)
Familiarity with programming in JavaScript and D3.js
Familiarity with big data technologies such as Hadoop, MapReduce, and AWS Kinesis
Demonstrated ability to develop innovative solutions to complex problems using advanced problem-solving skills and sound judgment
Knowledge of modern machine learning algorithms (clustering, classification and regression), statistical methods, and optimization
Knowledge of healthcare industry systems, business strategies, and products

Compensation

Greater New York City Area (NY, NJ, CT residents): USD 83,100 - 120,360 per year
All other locations (within approved locations): USD 73,400 - 109,225 per year

Location: New York, NY (hybrid)

Minimum experience: 3 years

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3d ago

Lead Data Scientist

Onos Health San Francisco, CA

San Francisco, CA

3d ago

$200k - $225k/yr Full time Manager Analytics Claims Analytics

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Job Description

Onos Health is hiring a Lead Data Scientist (hybrid) in San Francisco to take ownership of core analytics and AI model development for payers. The role is both strategic and hands-on, with a focus on measuring clinical appropriateness and identifying cost savings across behavioral health.

Responsibilities

Design and deploy predictive, risk-scoring, and optimization models to identify waste, inappropriate utilization, and care improvement opportunities across behavioral health services.
Contribute to the evolution of the data science stack, including feature stores and pipelines, as well as model monitoring and evaluation frameworks.
Analyze claims and clinical data to uncover trends, outliers, and actionable insights.
Partner with client-facing teams to translate complex models into clear insights that support ROI, payer workflows, and impactful dashboards.
Work closely with the CEO, CPO, and engineering team to shape product direction, data strategy, and key client engagements.

Requirements

8+ years of experience in data science or advanced analytics (healthcare or health plans preferred), with claims and clinical data experience strongly preferred.
Strong expertise in statistical modeling, causal inference, and machine learning.
Working proficiency with Python and SQL, plus related libraries such as scikit-learn, statsmodels, and PyTorch or similar tools.
Familiarity with healthcare data standards, including claims, eligibility, and EHR or clinical data, and coding sets such as ICD, CPT, and HCPCS.
Experience building production-grade models and deploying them in analytical or product environments.
Proven ability to build, mentor, and lead data science or analytics teams.
An entrepreneurial approach: resourceful, proactive, comfortable with ambiguity, and able to move quickly.
Strong communication skills, including the ability to translate complex analyses into business-relevant insights.
Exceptional references from colleagues and former managers.

Technologies

Python, SQL, scikit-learn, statsmodels, PyTorch, ICD, CPT, HCPCS

Location and Employment Details

Location: San Francisco, CA (hybrid)
Salary range: USD 200,000 - 225,000 per year
Minimum experience: 8 years

Benefits

Flexible hybrid schedule: approximately 3 days per week in the San Francisco office (Financial District)
Unlimited vacation policy
Paid parental leave
Medical, dental, and vision insurance
Pre-tax commuter benefits
401(k)
Significant equity as an early employee
Direct mentorship from experienced founders
Ground-floor opportunity to help build a team and culture
Regular team events and off-sites
Company-provided equipment and home office setup

Why Onos Health

Meaningful impact: help address fundamental problems in healthcare
Direct collaboration: work alongside experienced founders with deep healthcare and data expertise
Culture: join a high-performing, transparent, results-oriented team
Ownership: significant responsibility and autonomy from day one
Opportunity: play a pivotal role in building a fast-growing, category-defining healthcare AI company

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6d ago

Population Health Data Analyst

North Alabama Community Care Huntsville, AL

Huntsville, AL

6d ago

$85k+/yr Full time Analyst Claims Analytics Data Analysis

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Job Description

North Alabama Community Care is hiring a Population Health Data Analyst for a hybrid role based in Huntsville, AL. This position supports analytics that drive quality improvement and clinical management initiatives for Alabama Medicaid and NACC, using claims and standardized quality measures. If you value meaningful work, collaborative partnerships, and structured analytics at scale, this role offers a clear path to impact.

What You’ll Do

Deliver analytics support for the quality improvement plan, projects, activities, and clinical management initiatives prioritized by the Alabama Medicaid Agency and NACC.
Own the design, implementation, dissemination, and interpretation of population health analysis and reporting.
Use claims and administrative data to identify and measure key metrics that support improved quality of care and health outcomes for Medicaid recipients.
Build strong, collaborative relationships with internal and external partners across clinical, administrative, financial, and technical areas.
Work as a self-starter and independent contributor while coordinating with others and meeting tight deadlines.
Attend and present at quarterly in-person meetings in Montgomery, Alabama.
Attend and present at additional meetings in the northeast region as required.
Perform other duties as assigned.

What You Bring

Minimum: B.S. degree in a science, public health, or statistical-related field with seven (7) years of relevant experience in public health data analysis, epidemiology, or statistical analysis.
Preferred: Master’s or Doctorate degree in a science, public health, or statistical-related field with 3–5 years of relevant experience in public health data analysis, epidemiology, or statistical analysis.
SQL: At least 5 years writing SQL queries or similar languages, with knowledge of database design, data entry, and data management.
Data work at scale: At least 5 years managing large, complex, longitudinal datasets, including moving and merging data files across platforms, cleaning and aggregating data, and performing quality control.
Statistical tools: Experience using SAS, SPSS, or R for statistical analysis.
Visualization and reporting: Ability to use Tableau, Microsoft Excel, and Power BI to manipulate, analyze, and visualize data for dashboards and presentations.
External data sources: Knowledge and/or experience with external sources such as the Department of Public Health and the Centers for Disease Control (CDC).
Quality measures: Familiarity with HEDIS®, CAHPS, and other standardized quality measures/assessments.

Tools You’ll Use

SQL, SAS, SPSS, R, Tableau, Microsoft EXCEL, Power BI

Compensation, Schedule, and Employment Details

Salary: USD 85,000 per year (from $85,000.00 per year).
Schedule: Monday through Friday, 8:00am–5:00pm.
Employment status: Full-time, Exempt.
Job type: Full-time.
Location: Hybrid remote in Huntsville, AL 35805.
Relocation: Relocate before starting work (Required) for Huntsville, AL 35805.

Benefits

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

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7d ago

Data Analyst - Advance Analytics

State Farm Bloomington, IL

Bloomington, IL

7d ago

$81k - $123k/yr Full time Advanced Analytics Analyst Analytics

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Job Description

State Farm is seeking a Data Analyst for Claims-Advanced Analytics to drive strategic P and C Claims data visualization and dashboard initiatives. The role translates complex analytics into actionable insights for claims leadership, leveraging Power BI and Python and SQL to deliver decision-ready outputs.

Key Responsibilities

Spearhead high-impact, strategic projects centered on P and C Claims data visualization and dashboard creation.
Serve as a primary advisor to senior management by translating complex data and analytics into business insights.
Design, develop, and optimize dashboards using advanced analytical techniques to support critical claims strategies and operational decisions.
Define and communicate technical direction for software development, data integration, and ongoing support of visualization initiatives.
Own end-to-end project management, from planning through execution, to ensure delivery and strong relationships across cross-functional teams.
Work with a high degree of autonomy and influence, providing proactive guidance and advancing analytics and dashboard solutions.
Partner with business stakeholders to provide P and C Claims data that supports claim handling decisions, process improvements, and shifts in claim handling practices.
Collaborate with Data Scientists and analytics professionals to consult on or contribute to machine learning initiatives and to support creation of large datasets for data and technology-driven process improvements.
Use SQL and Python to extract and manipulate data from complex systems and produce consumable outputs aligned with business requirements.
Refine ambiguous business requirements using judgment, business understanding, research, and peer collaboration to deliver optimal results.
Manage multiple priorities and deadlines across agile and traditional environments with minimal oversight.

Required Qualifications

Demonstrated leadership delivering complex data visualization and dashboard projects, preferably in the P and C insurance or claims domain.
Prior experience in the Insurance industry.
Experience extracting and manipulating large datasets (1M+ records) and working with complex data systems.
Expertise with Power BI, Qlik, or similar visualization platforms.
Proficiency in SQL and Python for data extraction and manipulation.
Strong understanding of data architecture, integration, and analytics best practices.
Experience with cloud data environments, particularly AWS, and familiarity with on-prem data systems.
Excellent communication skills, including the ability to explain technical concepts to non-technical stakeholders.
Ability to navigate ambiguous requirements with a strategic mindset to identify transformative opportunities.
Exceptional project management skills and a client-focused approach.
Ability to work autonomously and manage multiple projects in both agile and non-agile settings.

Tools and Technologies

Power BI
Qlik
SQL
Python
AWS

Location and Salary

Location: Bloomington, IL (onsite)

Salary: USD 80,600 - 123,000 per year

Benefits

Potential starting salary range: $80,600.00 - $123,000.00
Potential yearly incentive pay up to 15% of base salary
Eligible for an annual raise and bonus
Robust health and wellbeing programs, with State Farm paying most of your healthcare premium, multiple healthcare plan options including a high deductible plan, 100% coverage for in-network preventative care, access to vision and dental, telemedicine, 24/7 mental health professionals, and more
Educational benefits including industry-leading training, tuition assistance, employee resource groups, and mentoring
Fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and savings account or financing through State Farm Federal Credit Union
Generous time off including initially up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service or education support days
Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund
Retirement support using free financial advisors and a 401(k) plan with company contributions up to 7% of your salary

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Claims Analytics Data Jobs

Sr Data Analyst, Healthcare Claims Audit and Compliance

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Population Health Data Analyst

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