Data Jobs in Kapolei, HI

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Claims Data Analyst

BerryDunn Kapolei, HI

Kapolei, HI

Today

$95k - $120k/yr Full time Claims Data Data Analysis Data Analytics

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Job Description

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 careers@berrydunn.com).

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)

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