Claims Data Analyst

BerryDunn • Kapolei, HI

3d • Hybrid

About The Position

BerryDunn is seeking a Claims Data Analyst to support Hawaiʻi Med-QUEST's (MQD) Fraud, Waste, and Abuse (FWA), Program Integrity, audit, Third Party Liability (TPL), payment integrity, claims review, and improper payment prevention initiatives. This position will provide high-quality data analysis, reporting, validation, and documentation support to help identify trends, risks, improper payments, billing anomalies, compliance considerations, cost avoidance opportunities, and recovery opportunities across Medicaid claims, provider, member, financial, operational, and program integrity data. The Claims Data Analyst will work closely with the Payment Integrity Subject Matter Expert (SME) and collaborate with team members to support operations, compliance, vendor management, and the future Program Integrity Unit at MQD. This includes analyzing Medicaid claims and related data; developing reports, dashboards, and data summaries; validating data quality and completeness; documenting findings; supporting issue tracking and monitoring activities; and communicating results to payment integrity, audit, TPL, program integrity, operations, policy, vendor, and project leadership teams. Travel expectations: This role may require travel up to 25% of the year.

Requirements

• 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 preferred.
• 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 preferred.
• Bachelor’s degree preferred; four years of applicable experience may be substituted for a degree.

Nice To Haves

• Experience supporting state Medicaid, healthcare claims, healthcare payment integrity, government program, systems, project coordination, or consulting initiatives preferred.
• 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.

Responsibilities

• Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to identify trends, risks, anomalies, billing patterns, and opportunities for operational improvement.
• Support the Payment Integrity Subject Matter Expert by preparing data summaries, dashboards, monitoring tools, reports, and decision-support products for payment integrity, claims audit, FWA, TPL, corrective action, and operational improvement activities.
• Conduct high-level Medicaid systems and claims data research related to billing codes, benefit groups, service limits, system configuration, requirements, electronic billing standards, and claims adjudication considerations.
• Assist with claims review and audit activities by validating data for accuracy, completeness, reasonableness, and alignment with Medicaid policies, program rules, and payment integrity priorities.
• Collaborate with payment integrity, Program Integrity, audit, TPL, Integrated IT, Process & Policy, operations, compliance, vendor, and project teams to support reporting, monitoring, data validation, and review prioritization activities.
• Support project coordination and transparency by contributing to data-related updates, issue tracking, workgroup materials, Jira-informed reporting, and documentation needed for team and leadership discussions.
• Document analytical findings, summarize data limitations, prepare recommendations for review by subject matter experts, and communicate results clearly to clients, team members, vendor partners, and project leadership.
• Support quality assurance reviews of reports, dashboards, analyses, documentation, and related work products.
• Stay current with Medicaid payment integrity, program integrity, claims audit, improper payment prevention, and relevant regulatory or industry trends.

Benefits

• Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level