Claims Data Pipelines

Claims Data Pipelines Jobs

6 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 Analyst Analytics

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Job Description

Healthfirst is expanding its Analytics team in New York, offering a Senior Analyst role focused on Audit and Compliance Analytics within healthcare claims. Based in New York with a hybrid work arrangement, the position collaborates across functions to detect risks, assess controls, and produce reporting that supports payment accuracy and operational excellence.

Responsibilities

Analyze complex healthcare datasets to reveal trends, anomalies, control gaps, and potential compliance or operational risks.
Support Internal Audit, Compliance Analytics, and Claims Configuration Audit activities through data analysis, audit testing, monitoring, and reporting.
Develop advanced SQL, SAS, or other analytical queries to extract, validate, and analyze data from multiple sources.
Evaluate data quality and standardize data structures to enable consistent reporting and analysis.
Create and maintain dashboards, scorecards, reports, and monitoring tools that provide actionable insights to leadership and business stakeholders.
Summarize findings, methodologies, and recommendations for technical and non-technical audiences.
Assist in the validation of 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.
Demonstrate intellectual curiosity and identify opportunities for process, control, and reporting improvements.
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 skills
Experience using MS Office suite, including Microsoft Access, Excel, and Word
Expertise in utilizing data analysis and query tools such as SQL
Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms
Experience with applied statistics skills, such as distributions, statistical testing, regression, etc.
Ability to successfully run queries from a data warehouse
Expertise innovating and implementing audit techniques
Excellent communication skills
Excellent time management and the ability to prioritize work and complete assignments within their allotted deadline
Experience working with and communicating technical information to multiple levels of technical and non-technical staff in written and verbal form
Experience prioritizing a heavy workload in a fast-paced environment

Technologies

SQL
SAS
Microsoft Access
Excel
Word
Alteryx
Tableau
Amazon Redshift
AWS
Glue
SageMaker
JavaScript
D3.js
Hadoop
MapReduce
AWS Kinesis
Python
R

Benefits

Medical, dental, and vision coverage
Incentive and recognition programs
Life insurance
401k contributions

Hiring Range

Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $109,225

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3d ago

Data Engineer

Information Technology Senior Management Forum Bloomington, IL 🇺🇸 Remote

Bloomington, IL

3d ago

$153k - $153k/yr Full time Big Data Claims Data Pipelines Data Analysis

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Job Description

Data Engineer role focused on designing and implementing complex knowledge graph structures to enhance claims investigation and fraud detection through advanced graph analytics, with responsibilities spanning data engineering, ETL, DataOps, and cross-functional collaboration; option to work remotely in the U.S.

Responsibilities

Design and implement complex knowledge graph structures to bolster claims investigations and fraud detection via advanced graph analytics
Collaborate with cross-functional teams to drive data driven decision making and innovation
Apply industry standard languages and frameworks across coding, testing, security, DevOps, DataOps and data engineering practices with graph database technologies
Develop and maintain reusable, scalable, and compliant data solutions across multiple platforms and compute environments
Identify, acquire, cleanse, profile, and ETL data used in analytic discovery and production solution deployment across multiple platforms
Establish business domain knowledge for existing State Farm data sources and evaluate, recommend, and initiate data resource acquisitions, internal or external
Identify and consult on emerging technologies and critical core systems, including techniques, tools, data sources, and platforms in the data engineering field
Be familiar with handling datasets containing mixes of structured and unstructured data
Exhibit a DataOps mindset, ensuring data aligns to enterprise needs and leveraging automation to deliver quality data solutions
Collect and analyze information to identify customers' technical needs, propose solutions and develop implementation and integration plans (eg, technical proposals)
Be responsible for the analysis, design, deployment, support, and security of technology to ensure efficient management of technology and data-related assets in line with market best practices and external regulations
Apply a broad application of complex principles, theories, and concepts in computer science for data engineering solutions

Requirements

Bachelor’s degree or foreign equivalent in Computer Science or a closely related field
5 years of experience in the offered role or as a Specialist Programmer, or similar positions such as Machine Learning Engineer or Graph Data Engineer
5 years of experience with graph database management systems (Neo4j or Amazon Neptune) and knowledge of Cypher
5 years of experience with distributed computing frameworks, including Apache Spark
5 years of experience with programming languages, including Python or Java, and Scala
5 years of experience with containerization and orchestration, including Docker, Kubernetes, leveraging Graph Algorithms Libraries, and Neo4j GDS

Technologies

Neo4j
Amazon Neptune
Cypher
Apache Spark
Python
Java
Scala
Docker
Kubernetes
Graph Algorithms Libraries
Neo4j GDS

Benefits

Get Paid: eligible for annual raise and bonus on top of competitive pay
Stay Well: robust health and wellbeing programs; employer pays most healthcare premiums; multiple plans including high deductible; 100% in-network preventive care; vision, dental, telemedicine, 24/7 mental health support, and more
Develop and Grow: access to industry leading training, tuition assistance, employee resource groups, and mentoring
Plan Ahead: fertility/ IVF/ adoption assistance, college coaching, national discount programs, monthly financial workshops, free financial coaching, and savings account options or credit union access
Take a Little “You” Time: generous time off to plan around holidays, family events, volunteering; up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days
Give Back: Matching Gift Program, Good Neighbor Grant Program, and Employee Assistance Fund
Finish Strong: free financial planning and a 401(k) plan with company contributions up to 7%

Salary

USD 152,734 per year

Type

Full-time

Location

Bloomington, IL (remote)

Job ID

44799

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4d ago

Sr. Clinical Informatics Data Engineer

Mingle Health Remote 🌍 Remote

Remote

4d ago

Full time Senior Claims Data Pipelines Clinical Data

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Job Description

At Mingle Health, a remote-first organization focused on healthcare data solutions, the Senior Clinical Informatics Data Engineer will translate CMS specifications into database structures used for analysis and quality measurement. The role centers on building scalable data pipelines, validating data quality, and supporting CMS submissions and Medicare reporting for healthcare clients. You will collaborate with a distributed team to ensure data accuracy and timely reporting across client projects.

Responsibilities

Interpret and codify CMS Quality Payment Program specifications, translating them into robust data models and database objects for quality measures.
Analyze accuracy and performance of claims and clinical data using MS SQL and related tools, ensuring data quality across datasets.
Provide data mapping for claims and clinical datasets via internal web application software.
Translate measure specifications into database structures used to compute quality measures.
Act as a client consultant for assigned practices and hospital systems to support successful CMS submissions.
Develop ad hoc SQL reports to support client consulting needs.
Validate data load processes into clinical data repositories to maintain data integrity.
Collaborate with colleagues to document data requirements and metric definitions.
Perform quality assurance for data integration processes and repository metrics.
Participate effectively within a distributed, remote team and contribute to client-facing and internal development efforts.
Apply strong communication and interpersonal skills to manage projects and coordinate with stakeholders.

Requirements

Minimum five years of experience in healthcare or clinical informatics.
Hands-on experience with medical or clinical information systems used by clients, such as electronic health records and practice management systems.
Familiarity with medical processes, terminology, physician office systems, or billing including Medicare and other payers.
Experience with quality reporting and familiarity with MIPS and Advanced Payment Models programs.
Ability to review, interpret, compare, and edit clinical documentation, including CMS Measure Specifications Manual for Claims and Registry Reporting.
Strong client requirements gathering and the ability to translate needs into actionable solutions.
Ability to guide clients in constructing queries, extracting data, assessing data quality, and improving data quality, flow, and metrics.
Solid programming skills with proficiency in SQL; ability to develop, execute, and evaluate Microsoft SQL queries.
Experience building and optimizing data pipelines and transforming raw data into analysis-ready information.
Ability to create data migration scripts using SSIS and/or Python, and facilitate importing of third-party data into data structures.
Experience maintaining efficient data loading processes and investigating data migration exceptions.
Contribute to planning, analysis, design, and development of data management processes, data integration, data warehousing, and BI solutions.
Ability to analyze large datasets in detail to diagnose issues, including reading error logs, executing stored procedures, and understanding data structures.
Foundational understanding of best practices for database design and maintenance.
Comfort with a fast-changing environment, incomplete documentation, and evolving roles while maintaining strict HIPAA privacy and security compliance.

Technologies

SQL
SQL Server
SSIS
Python

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10d ago

Senior Data Analyst - Post Payment Analytics

Ibility Remote 🌍 Remote

Remote

10d ago

Full time Senior Analyst Analytics

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Job Description

Ibility is seeking a Senior Data Analyst to lead post-payment analytics within its healthcare data practice. This remote, full-time position focuses on transforming complex healthcare claims data into actionable insights that inform payment integrity initiatives and data-driven decision-making. The role collaborates with program leadership, business stakeholders, and technical teams to translate analytical findings into operational improvements using Databricks and a broad set of analytics tools.

Position overview

The Senior Data Analyst – Post Payment Analytics analyzes healthcare claims data to support post-payment analytics, payment integrity initiatives, and data-driven decision-making. This role works with program leadership, business stakeholders, and technical teams to convert intricate claims information into insights that enhance operational performance, identify payment trends and anomalies, and ensure compliance with data governance standards.

Responsibilities

Analyze large and complex healthcare claims datasets to support post-payment analytics, payment integrity initiatives, and program objectives.
Develop, maintain, and optimize analytical datasets, reports, dashboards, and visualizations using Databricks and other analytics tools to support business and operational needs.
Collaborate with program managers, functional leads, technical teams, and government clients to gather, interpret, and translate business requirements into actionable analytical solutions.
Perform advanced data analysis to identify payment trends, anomalies, overpayments, and opportunities for operational improvement while ensuring data accuracy and integrity.
Validate, reconcile, and monitor healthcare claims data to ensure consistency, completeness, and compliance with established data governance standards.
Provide analytical expertise and recommendations to stakeholders by presenting findings, communicating insights, and supporting data-driven decision-making.

Requirements

Bachelor's degree in Data Analytics, Computer Science, Information Systems, Healthcare Informatics, Statistics, Mathematics, or a related field. Equivalent combination of education and relevant experience may be considered.
Minimum of 4 years of experience performing data analytics, data analysis, or business intelligence activities.
Minimum of 3 years of hands-on experience developing analytical solutions using Databricks.
Demonstrated experience working with healthcare claims data, including the analysis, validation, and interpretation of large and complex datasets.
Experience developing reports, dashboards, data visualizations, and analytical products to support business operations and executive decision-making.
Strong analytical and problem-solving skills with the ability to identify trends, anomalies, and opportunities for process improvement.
Experience translating business requirements into analytical solutions and presenting technical findings to both technical and non-technical stakeholders.
Knowledge of data governance principles, data quality management, and best practices for maintaining data integrity.
Excellent written and verbal communication skills, with the ability to effectively collaborate across cross-functional teams and government stakeholders.
Ability to manage multiple priorities, meet deadlines, and work independently in a fast-paced, client-focused environment.

Technologies

Databricks
Power BI
Tableau
SQL
Python

Benefits

Health, Dental, and Vision Plans
Short Term Disability / Long Term Disability / Life Insurance / Accidental Death and Dismemberment
Health Savings Account
Unlimited Paid Time Off
11 Federal Holidays Off
401K

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11d ago

Data Analyst III

Centene St. Louis, MO 🇺🇸 Remote

St. Louis, MO

11d ago

$70k - $126k/yr Full time Analyst Analytics Business Intelligence

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Job Description

The Data Analyst III role at Centene centers on Internal Audit Claims analytics, handling data extraction, validation, reporting, and automation support for claims audit processes. This is a remote position based in Missouri with nationwide U.S. eligibility, offering a salary range of USD 70,100 to 126,200 per year.

Responsibilities

Support Internal Audit Claims analytics, including recurring claims audit sampling, executive reporting, AuditWell support, Power BI dashboard support, error and CAP trend analysis, and repeatable management-ready analytics.
Extract, transform, reconcile, and validate large healthcare claims datasets across enterprise data sources such as claims, provider, member, financial, operational, and audit-related data.
Perform structured QA, reconciliation, tie-outs, and validation of claims audit reporting, sampling outputs, dashboards, automation results, and executive-ready deliverables.
Develop and maintain recurring reports, dashboards, and analytical deliverables using SQL, Power BI, Excel, Snowflake, Teradata, MS SQL Server, or similar data warehouse and BI tools.
Collaborate with audit, data analytics, IT, and business stakeholders to translate reporting, sampling, and automation needs into repeatable data processes, documentation, and validated outputs.
Support automation, bot, AI, and process-improvement initiatives through requirements translation, testing support, output validation, documentation, and controlled implementation.
Identify data issues, trends, process gaps, and reporting improvement opportunities; communicate findings clearly to management to support timely resolution.
Assist with training and mentoring other Data Analysts.

Requirements

Bachelor’s degree in a related field or equivalent experience.
4+ years of statistical analysis or data analysis experience.

Technologies

SQL
Power BI
Excel
Snowflake
Teradata
MS SQL Server
C#
.NET
Python
Alteryx

Benefits

Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field, or office schedules

Position Purpose

Responsible for the analytic data needs of the business unit. Manage complex data projects and serve as a lead resource for other Data Analysts. This Internal Audit Claims role supports claims audit execution through sampling, executive reporting, QA and reconciliation, Power BI/dashboard support, automation validation, bot and AI enablement, and repeatable management-ready analytics.

Required Education/Experience

Bachelor’s degree in a related field or equivalent experience. 4+ years of statistical analysis or data analysis experience.

Preferred Skills

Advanced SQL experience, including extracting, joining, reconciling, and validating large datasets from enterprise data warehouse environments.
Power BI experience, including Power BI Desktop, Power BI Service, workspace and report maintenance, refresh validation, access and security coordination, and service-account-based reporting processes.
Healthcare claims analytics experience strongly preferred, especially with post-pay claims data, claims processing systems, audit/compliance reporting, or quality review processes.
Experience with Snowflake, Teradata, MS SQL Server, EDW, or similar enterprise data platforms.
Strong data quality and reconciliation mindset, including structured tie-outs, report validation, issue documentation, and validation of automated reporting outputs.
Experience supporting automation, ETL, API-based processes, C#, .NET, Python, Alteryx, or similar workflow and process-improvement efforts.
Ability to translate technical findings into concise, management-ready explanations for audit leadership, business stakeholders, and cross-functional partners.

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22d ago

Data Engineer – Healthcare Analytics Platform

Guidehouse Washington, DC

Washington, DC

22d ago

$77k - $129k/yr Full time Analytics Business Intelligence Claims Data Pipelines

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Job Description

Guidehouse is seeking a Data Engineer to design and implement an enterprise Contract Performance Analytics platform for a large healthcare system. This onsite role in Washington, DC centers on data architecture, ELT/ETL pipeline development, and the integration of clinical, claims, and operational data to power analytics across the organization.

Responsibilities

Design, develop, and maintain robust ETL/ELT pipelines to ingest, transform, and load healthcare data from diverse structured and unstructured sources
Create pipelines to process data from CMS and payer files (CCLF, paid claims, PUG) as well as Epic Caboodle and Clarity data models and extracts
Build and optimize data models to support analytics, reporting, and operational use cases, including BI and downstream analytics consumption
Transform raw data into standardized, analytics-ready canonical data models and curated data marts
Develop lakehouse or medallion architecture, data ingestion patterns, and orchestration frameworks
Implement and maintain CI/CD pipelines for data engineering workflows, including pipelines and scheduled jobs, using version control and automation tools
Collaborate with database administrators, analysts, and application teams to integrate data sources, design schemas, and support downstream data consumers
Ensure data quality, integrity, and accuracy through validation, monitoring, logging, and alerting
Support data migration, integration, and modernization initiatives, including legacy upgrades, optimization of large-scale ETL pipelines, query performance, and cloud adoption efforts
Troubleshoot and resolve issues in development and production environments to maintain stable and reliable data pipelines
Document data flows, pipelines, test cases, and technical solutions to support knowledge sharing and compliance requirements
Stay current with emerging tools, technologies, and best practices in data engineering and cloud platforms

Requirements

US Citizenship or a Green Card is required
Bachelor’s degree in Computer Science, Data Analytics, Software Engineering, Information Systems, or related fields
Minimum of five (5) years of experience in data engineering, ETL/ELT development, or data platform engineering in a healthcare setting
Experience working with healthcare data, including claims, clinical, payer, or population health datasets
Experience with healthcare data interoperability standards (e.g., FHIR, HL7)
Proficiency in Python and SQL for data engineering and transformation workloads
Hands-on experience designing and building ETL/ELT pipelines and data ingestion frameworks
Experience with modern cloud data platforms or ETL/ELT tools (e.g., Databricks, Azure Data Factory, AWS Glue)
Experience working with lakehouse or medallion-style architectures for analytics platforms
Strong knowledge of relational database design, data warehouses, and/or data lakes (e.g., star/snowflake schemas)
Experience with relational and/or distributed data systems, including data modeling
Experience working in a cloud environment (AWS or Azure) supporting data solutions
Experience with CI/CD practices and version control tools (e.g., Git)
Experience using monitoring and logging tools to support data pipeline reliability
Experience working with PHI and healthcare data privacy/security requirements
Ability to work effectively in an Agile development environment
Strong analytical and troubleshooting skills, with the ability to convey technical concepts clearly to clients, engineers, and business stakeholders
Ability to work independently in a fast-paced, client-facing environment

Technologies

Python
SQL
Databricks
Azure Data Factory
AWS Glue
Git
Tableau
Power BI
AWS
Azure

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Student Loan PayDown
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
Mobility Stipend

Nice to have

Previous experience working with Epic and/or Athena in a healthcare setting for data engineering
Previous experience with Exasol or similar analytics platform
AWS, Azure, Databricks, Snowflake or other data engineering–related certifications
Experience with data visualization or analytics tools (e.g., Tableau, Power BI)
Exposure to microservices-based architectures or AI/ML-enabled data pipelines
Prior consulting experience

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Claims Data Pipelines Jobs

Sr Data Analyst, Healthcare Claims Audit and Compliance

Data Engineer

Sr. Clinical Informatics Data Engineer

Senior Data Analyst - Post Payment Analytics

Data Analyst III

Data Engineer – Healthcare Analytics Platform

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