Senior Data Analyst - Remote

The Senior Data Analyst is the analytics owner for a healthcare claims reprocessing and payment integrity team operating across two health plan markets. The team handles overpayment recovery, claims reprocessing, provider contestment review, and the operational reporting that supports each. This role builds and maintains the data products the team and its leadership rely on to manage day-to-day work and to demonstrate performance against operational targets., * Design, build, and maintain operational dashboards and reports that track reprocessing cycle time, post-approval turnaround, queue and hold status, stalled or aging tickets, contestment volume, and recovery throughput.

• Write and optimize complex SQL against multiple claims adjudication systems and an enterprise data platform, including queries that join claims data to ticketing and workflow data through established crosswalks.

• Replace manual, ad-hoc extracts with documented, repeatable, and parameterized data pulls so that recurring reports are consistent and reproducible from one period to the next.

• Translate operational questions from team leadership into clear reporting requirements, and document those requirements so the logic behind each metric is transparent and defensible.

• Conduct ad-hoc analysis to answer time-sensitive operational and prioritization questions, including high-dollar case identification and workload distribution across reviewers and analysts.

• Support data quality and stewardship efforts: validate that source data ties out, identify and document data gaps or anomalies, and flag conditions that would make a metric unreliable before it reaches leadership.

• Partner with IT and data platform teams on data access, source structure, and the migration of operational data off manual processes onto governed, auditable platforms.

• Produce reporting that is appropriate for a regulated, audited environment, including clear sourcing and documentation of report logic, while keeping the role’s outputs limited to operational status and analytics rather than financial estimates or accounting determinations.

• Promote self-service reporting where appropriate by building reusable, well-documented data products rather than serving every request as a one-off.

• Bachelor’s Degree in Data Analytics, Information Systems, Health Informatics, Computer Science, Statistics, or a related quantitative field. (Required)

Certification/Licensure

• Relevant certification such as a coding credential (CPC), a Microsoft data or Power BI certification, or a SQL or database certification., * Five or more years of progressive data analysis experience, with at least two years working directly with healthcare claims, payer operations, or payment integrity data. (Required)
• Demonstrated experience writing production-grade SQL against relational databases independently, not solely through a drag-and-drop reporting layer. (Required)
• Advanced SQL, Data visualization and BI development, with hands-on Power BI experience
• Python coding, data warehouse using Synapse
• Exposure to workflow or ticketing systems and to joining workflow data to claims data.
• Ability to gather and document reporting requirements and to explain the logic behind a metric to a non-technical operations audience.
• Data Quality, Data Validation experience
• Experience working with IT and Data teams
• Experience with a claims adjudication platform (QNXT, Facets, or a comparable payer system) and with claims data structures such as claim, line, member eligibility, provider, and coordination of benefits.
• Familiarity with operating in an ICFR or SOX regulated environment and producing reporting that supports audit and control requirements.
• Familiarity with or hands-on use of AI and large language model tools

Talroo

Keywords: Data Analysis, SQL, Data visualization, BI, Python, Synapse, claims adjudication, data quality, QNXT, Facets, payer claim, ICFR, SOX, healthcare data analysis, payment integrity, payer operations, healthcare claim, data validation

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for full-time employment is $80,204.80 - $133,681.60. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.