Payment Integrity Analytics Specialist

PACIFICSOURCE

. 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

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare analytics, claims analytics, and payment integrity, with a strong focus on data analysis, reporting, and performance measurement. Proficient in utilizing SQL, Power BI, and Tableau for effective reporting and decision-making support.

Highest-signal resume keywords

Healthcare AnalyticsClaims AnalyticsPayment IntegritySQLPower BI

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data AnalysisReporting TechniquesStatistical AnalysisPerformance MeasurementReimbursement AnalysisData ValidationQuality AssuranceBudgetingForecastingOperational Performance Metrics

Soft Skills

Clear CommunicationCollaborationDecision-MakingProblem-SolvingAttention to Detail

Tools & Technologies

Microsoft ExcelPower BITableauReporting Tools

Industry Keywords

Healthcare Claims ProcessingMedicareMedicaidCommercial Health PlansMarketplace Health PlansFraud DetectionWaste and Abuse DetectionComplianceHIPAA

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 and assigned projects
Participate in compliance and operational initiatives as needed
Perform other duties as assigned
Collaborate with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors

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 read and comprehend both written and spoken English
Ability to communicate clearly and effectively
Ability to meet department and company performance and attendance expectations
Ability to follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and light lifting and carrying
Travel required approximately 5% of the time

Benefits

Comp & perks

Equal opportunity employment
Work-from-home arrangement
Ergonomically configured equipment
Opportunities to participate in community, social justice, equity, diversity, and inclusion initiatives