Claims Data Analyst

Claims Data Analyst role focused on Medicaid payment integrity, program integrity, and claims analytics for Hawaiʻi Med-QUEST.

Responsibilities

• Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to surface trends, risks, billing anomalies, and improvement opportunities.
• Support the Payment Integrity Subject Matter Expert with data summaries, dashboards, monitoring tools, reports, and decision-support outputs for payment integrity, claims audit, FWA, TPL, corrective action, and operational improvement work.
• Perform high-level research on Medicaid systems and claims data, including billing code and benefit group review, service limit considerations, system configuration, electronic billing standards, and claims adjudication considerations.
• Assist claims review and audit efforts by validating data for accuracy, completeness, reasonableness, and alignment with Medicaid policies, program rules, and payment integrity priorities.
• Coordinate with payment integrity, Program Integrity, audit, TPL, Integrated IT, Process & Policy, operations, compliance, vendor, and project teams to enable reporting, monitoring, data validation, and review prioritization.
• Contribute to project transparency by producing data-related updates, issue tracking inputs, workgroup materials, Jira-informed reporting, and documentation for team and leadership discussions.
• Document analytical findings, summarize data limitations, provide recommendations for subject matter expert review, and communicate results to clients, team members, vendor partners, and project leadership.
• Support quality assurance reviews for reports, dashboards, analyses, documentation, and related deliverables.
• Stay current on Medicaid payment integrity, program integrity, claims audit, improper payment prevention, and relevant regulatory or industry trends.

Requirements

• Experience collecting, analyzing, validating, and interpreting data to meet business, operational, compliance, payment integrity, or program integrity objectives.
• Experience analyzing healthcare, Medicaid, claims, billing, audit, compliance, payment integrity, or government program data.
• Strong skills in data analysis, reporting, dashboarding, SQL, statistical analysis, visualization, or related analytical methods.
• Ability to translate analytical findings into practical insights, operational recommendations, compliance considerations, monitoring approaches, or review priorities.
• Experience supporting state Medicaid, healthcare claims, healthcare payment integrity, government program, systems, project coordination, or consulting initiatives preferred.
• Strong capabilities in analysis, problem-solving, written communication, collaboration, organization, and attention to detail.
• Minimum 1 year of experience in a comparable analytics, claims, payment integrity, program integrity, compliance, healthcare, Medicaid, systems, or consulting role preferred.
• Experience with Microsoft applications, data analysis/reporting tools, Jira (or similar work tracking tools), and artificial intelligence tools for analysis, documentation, or quality assurance preferred.
• Bachelor’s degree preferred; four years of applicable experience may be substituted.

Technologies

• SQL
• Microsoft applications
• Jira
• Artificial intelligence tools

Travel Expectations

• May require travel up to 25% of the year.

Compensation

• Target base salary range: $95,000 - $120,000 per year.

Benefits

• Eligible employees have access to benefits designed to support physical, mental, career, social, and financial well-being.
• Reasonable accommodation available for individuals participating in the application or interview process or performing essential job functions (contact [email protected]).

Preferred Qualifications/Experience

• Experience supporting Medicaid, health and human services, claims, encounter, payment integrity, program integrity, audit, TPL, or integrated eligibility system initiatives.
• Experience working with vendor-managed Medicaid systems, claims platforms, or similar public sector technology environments.
• Experience developing dashboards, reports, monitoring tools, data summaries, validation materials, or analytical documentation for leadership or stakeholder review.
• Experience coordinating with payment integrity, audit, TPL, program integrity, operations, policy, compliance, vendor, and project leadership teams.

Location: Kapolei, HI (onsite)

Salary: USD 95,000 - 120,000 per yearly

Minimum Experience: 1 years

Education: Bachelor’s degree (preferred)