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

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

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

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

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

Sr Data Analyst, Healthcare Claims Audit and Compliance

Job Description