Integrity Analytics Specialist

Position: Payment Integrity Analytics Specialist
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Pacific Source is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. Pacific Source values the diversity of our community, including those we hire and serve.

We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The Payment Integrity Analytics Specialist is responsible for data analysis, reporting, savings measurement, recovery tracking, operational performance monitoring, and identification of payment integrity opportunities. This role develops reports, dashboards, and analytical insights that support payment integrity operations, FWA prevention efforts, vendor oversight, and operational decision-making. The Analytics Specialist works closely with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors to transform data into actionable business insights.

Essential Responsibilities:

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards.
• Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics.
• Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends.
• Support fraud, waste, and abuse detection efforts through data analysis and reporting.
• Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures.
• Develop recurring operational, financial, and executive reporting.
• Perform data validation, reconciliation, and quality assurance activities.
• Support audit targeting, provider outlier analysis, and recovery opportunity identification.
• Create ad hoc analyses and presentations to support leadership decision-making.
• Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility.
• Identify trends, risks, and opportunities and provide data-driven recommendations to leadership.
• Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs.
• Support regulatory reporting, audits, and documentation requests.
• Participate in departmental meetings and assigned projects.

Supporting Responsibilities:

• Participate in compliance and operational initiatives as needed.
• Meet department and company performance and attendance expectations.
• Follow the Pacific Source privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required.

Education, Certificates, Licenses: Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred. High school diploma or equivalent required.

Knowledge: Healthcare claims processing and reimbursement methodologies. Data analysis and reporting techniques. Microsoft Excel and reporting tools. SQL, Power BI, Tableau, or similar reporting platforms preferred. Medicare, Medicaid, Commercial, and Marketplace health plan…