Payment Integrity Analytics Specialist

PacificSource Health Plans

. Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards .

Posted 9/17/2026full-timeRemote • United StatesMid-LevelSenior💰 $56,780 - $96,526 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare analytics, claims analytics, and payment integrity, with a strong focus on data analysis, reporting, and performance measurement. Proficient in utilizing tools like SQL, Power BI, and Tableau to drive data-driven decision-making and support operational initiatives.

Highest-signal resume keywords

Healthcare AnalyticsClaims AnalyticsPayment IntegrityData AnalysisSQL

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisReporting TechniquesStatistical AnalysisPerformance MeasurementReimbursement AnalysisData ValidationQuality AssuranceBudgetingForecastingOperational Performance Metrics

Soft Skills

Clear CommunicationEffective Collaboration

Tools & Technologies

Microsoft ExcelPower BITableauSQL

Industry Keywords

Healthcare Claims ProcessingMedicareMedicaidCommercial Health PlansMarketplace Health PlansFraud DetectionWaste and Abuse DetectionHIPAA Compliance

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards
Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics
Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends
Support fraud, waste, and abuse detection efforts through data analysis and reporting
Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures
Develop recurring operational, financial, and executive reporting
Perform data validation, reconciliation, and quality assurance activities
Support audit targeting, provider outlier analysis, and recovery opportunity identification
Create ad hoc analyses and presentations to support leadership decision-making
Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility
Identify trends, risks, and opportunities and provide data-driven recommendations to leadership
Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs
Support regulatory reporting, audits, and documentation requests
Participate in departmental meetings, assigned projects, compliance initiatives, and operational initiatives
Perform other duties as assigned

Requirements

What you’ll need

Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required
High school diploma or equivalent required
Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred
Knowledge of healthcare claims processing and reimbursement methodologies
Knowledge of data analysis and reporting techniques
Knowledge of Microsoft Excel and reporting tools
Knowledge of statistical analysis and performance measurement concepts
SQL, Power BI, Tableau, or similar reporting platforms preferred
Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred
Ability to follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Ability to read and comprehend both written and spoken English
Ability to communicate clearly and effectively
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials
Ability to meet department and company performance and attendance expectations

Benefits

Comp & perks

Equal opportunity employer
Work-from-home arrangement indicated by location field (WFH: GA)
Ergonomically configured equipment
Travel approximately 5% of the time
Employment remains at-will