Claims Data Analyst
$95,000–$120,000 year
On-siteKapolei, Hawaii, United States
Job Summary
Analyze Medicaid claims, provider, member, and program integrity data to identify trends, risks, and billing anomalies for fraud, waste, and abuse initiatives. Prepare data summaries, dashboards, and monitoring tools to support payment integrity, audit, and operational improvement activities. Validate data accuracy and completeness against Medicaid policies while collaborating with subject matter experts, vendors, and leadership teams on issue tracking and reporting. Document analytical findings, communicate results to stakeholders, and stay current with regulatory trends to drive cost avoidance and recovery opportunities. This role requires up to 25% travel and supports the future Program Integrity Unit at Hawaiʻi Med-QUEST.
Required Qualifications
- Experience collecting, analyzing, validating, and interpreting data to support business, operational, compliance, payment integrity, or program integrity objectives
- Experience analyzing healthcare, Medicaid, claims, billing, audit, compliance, payment integrity, or government program data
- Strong data analysis, reporting, dashboarding, SQL, statistical, visualization, or related analytical skills
- Experience translating data findings into practical insights, operational recommendations, compliance considerations, monitoring approaches, or review priorities
- Strong analytical, problem-solving, written communication, collaboration, organization, and attention-to-detail skills
- Minimum one (1) year of experience in a comparable analytics, claims, payment integrity, program integrity, compliance, healthcare, Medicaid, systems, or consulting role
- Bachelor's degree, four years of applicable experience may be substituted for a degree
- Travel up to 25% of the year
Desired Qualifications
- Experience supporting state Medicaid, healthcare claims, healthcare payment integrity, government program, systems, project coordination, or consulting initiatives
- Experience with Microsoft applications, data analysis tools, reporting tools, Jira or similar work tracking tools, and artificial intelligence tools to support analysis, documentation, or quality assurance
- 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
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