Claims Data Analyst

Job Description

We are seeking a Claims Data Analyst to join our growing team. The ideal candidate is highly organized, detail-oriented, enjoys working with data, and thrives in a fast-paced, entrepreneurial environment. This role serves as a critical bridge between Sales, Healthcare Economics, Network Strategy, and Account Management by supporting the evaluation and sale of medical provider network solutions to self-funded employers, third-party administrators, brokers, consultants, and stop-loss vendors.

In this position, you will analyze prospective clients’ historical medical claims and eligibility data to evaluate provider disruption, network discounts, repriced claim costs, geographic access, and overall network fit. You will translate complex claims data into clear findings that help internal teams and prospective clients understand the expected performance and implications of different provider network options. You will also play a key role in improving the company’s internal claims-analysis methodologies, reporting tools, and data-processing capabilities.

Roles & Responsibilities

• Analyze prospective clients’ historical medical claims, eligibility, and provider data to evaluate provider disruption, network discounts, repriced costs, geographic access, and overall network fit.

• Partner with the Technology team to develop, test, validate, and improve internal claims-analysis and reporting tools.

• Validate incoming data, identify material data-quality issues, and document assumptions or limitations affecting the analysis.

• Apply healthcare reimbursement methodologies, fee schedules, provider contract terms, and claims coding knowledge to claims repricing and network analyses.

• Review repriced claims and modeling outputs for accuracy, consistency, and reasonableness.

• Compare provider networks, reimbursement arrangements, and other market alternatives.

• Translate analytical findings into clear reports, presentations, and recommendations for Sales, brokers, consultants, TPAs, and prospective clients.

• Support prospective client meetings, RFP responses, renewals, and other sales opportunities by explaining methodologies, findings, and financial implications.

• Coordinate analytical requirements, priorities, timelines, and deliverables across Sales, Healthcare Economics, Network Strategy, Account Management, and Technology.

• Maintain and improve analytical models, reporting templates, methodologies, and internal claims-analysis tools.

• Identify opportunities to improve data processing, quality assurance, standardization, and automation.

• Support ad hoc analyses, competitive research, strategic initiatives, and stop-loss rating requests as needed.

• Protect confidential information and protected health information in accordance with company policies, HIPAA requirements, and applicable data-security standards.

• Identify updates and enhancements to current sales and healthcare economics analytics process.

• Prepare sales team for prospective client meetings with analytical results.

• Ensure analytics reports are completed timely and accurately.

• Develop and respond to request for proposals (RFPs) in coordination with the Business Development lead by due date.

• Responsiveness to Sales and other internal stakeholders, generally within 24 to 48 hours based on the urgency and complexity of the request.

Education and Qualification Requirements

• The ideal candidate will have 2-5 years’ experience in healthcare claims analysis, provider network analytics, health insurance, healthcare economics, managed care analytics, or a related field.

• Bachelor’s degree in business, finance, economics, statistics, healthcare administration, data analytics, or a related field. Equivalent…