Description :

We are looking for a Senior Data Analyst with strong expertise in healthcare claims data to drive high-impact analytics and validation initiatives. This role plays a key part in ensuring that insights, reporting, and automation outputs align with real-world claims processing logic and business rules.

You will work closely with operations, analytics, and technology teams to improve claims accuracy, enhance automation, and support data-driven decision-making.

Key Responsibilities :

Claims Data Analysis :

- Analyze medical and behavioral claims data to uncover trends, patterns, and discrepancies

- Understand the complete claims lifecycle including submission, edits, denials, adjustments, and adjudication

- Evaluate claim outcomes against benefit rules, eligibility criteria, and provider agreements

- Support initiatives focused on first-pass resolution, automation, and claims optimization

Data Validation & Domain Expertise :

- Validate datasets used in reporting, dashboards, and advanced analytics models

- Identify inconsistencies between business rules and system-generated outcomes

- Act as a subject matter expert for claims data, supporting analytics and engineering teams

- Assist in testing and validating outputs for automation and AI-driven use cases

Reporting & Insights :

- Develop and maintain reports and dashboards tracking claims performance metrics

- Monitor key indicators such as processing time, quality, and automation efficiency

- Provide clear, audit-ready insights for leadership and business stakeholders

Cross-Functional Collaboration :

- Work with operations and product teams to translate business processes into analytical requirements

- Partner with data engineering teams to ensure accurate data sourcing and transformation

- Participate in requirement discussions, backlog refinement, and solution validation

Required Experience & Domain Knowledge :

- 5+ years of experience in data analysis within healthcare or insurance domains

- Strong understanding of healthcare claims workflows including edits, denials, and rework

- Hands-on experience working with large-scale claims datasets

- Familiarity with claims processing systems and reference platforms (preferred)

- Understanding of benefit structures, policy rules, and member/provider data relationships

Technical Skills :

- Strong SQL skills for querying and analyzing large datasets

- Experience with data warehouses and enterprise analytics platforms

- Proficiency in Excel and BI/reporting tools

- Ability to translate complex data into actionable insights

- Exposure to data validation for AI/ML models is an added advantage

Qualifications :

- Bachelors degree or equivalent practical experience

- Strong analytical thinking and problem-solving ability

- Excellent communication skills to work with both technical and business stakeholders

What Success Looks Like :

- High-quality, reliable datasets that reflect actual claims processing logic

- Improved accuracy and efficiency in claims analytics and reporting

- Strong support for automation and AI initiatives through validated data

- Increased confidence from stakeholders in analytical outputs