Payment Integrity Analyst - Data Mining & Savings Reporting

MVP Health Care

1d • $69,383 - $92,279 • Remote

About The Position

In this role you’ll use advanced data mining and analytical techniques to identify improper payments, uncover cost savings opportunities, and support accurate, compliant claims payment across our health plan and report on financial trends. The role plays a critical part in protecting healthcare affordability for our members while supporting operational and financial decision‑making across the organization.

Requirements

• Bachelor’s degree in healthcare administration, business, data science, or a related field or 5 years of equivalent experience in healthcare billing, claims adjudication, payment integrity operations, or healthcare reimbursement analytics
• 3+ years of experience working with healthcare data analysis, group health business, or provider practice preferred.
• Strong experience analyzing large healthcare datasets using SQL or modern data tools (e.g., Snowflake, dbt, Looker, Python)
• Advanced analytical skills with the ability to interpret complex data and derive meaningful insights.
• Detail-oriented with a high level of precision and accuracy in handling critical data.
• Strong critical thinking, problem-solving, and communication skills (oral and written).
• Ability to work independently and collaboratively in a fast-paced, high-growth environment.
• Skilled at preparing clear, actionable documentation and executive-level summaries.

Nice To Haves

• Experience with claims, payment integrity, or Medical Economics, especially in Medicare Advantage and/or New York Medicaid is a plus
• Intermediate knowledge of local, state, and federal laws and regulations pertaining to health insurance is a plus.

Responsibilities

• Build, maintain, and enhance data pipelines that support payment integrity and savings analysis initiatives
• Analyze healthcare claims data to identify improper payments, wasteful spend, and cost reduction opportunities
• Perform deep-dive statistical analysis, predictive modeling, and experimental design to inform business strategies and operational improvement
• Conduct detailed reviews of claims history, provider files, and medical reviews to identify billing irregularities and financial trends
• Collaborate with cross‑functional partners to quantify and report savings generated by payment integrity activities
• Develop and deliver actionable insights and evidence-backed referrals that reduce health insurance costs
• Prepare and present savings reports, trending analyses, and recommendations to stakeholders
• Identify and resolve data quality issues, including discrepancies or missing data
• Ensure all analysis and reporting complies with regulatory requirements and internal policies

Benefits

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
• Pay Transparency

What This Job Offers

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