Data Analyst, Payer Intelligence

Role Description

The Payer Intelligence Data Analyst manages payer, plan, and claim-routing data that supports operational workflows, appeals, and automation across the organization. This role is responsible for payer master data integrity, plan standardization, routing logic, and submission rules to ensure accurate, scalable, and automation-ready operations. The analyst partners with Business Transformation, Denials Operations, Product, AI, Engineering, Data, and Client Implementation teams to maintain reliable payer infrastructure and improve workflow performance as systems evolve.

Key Responsibilities

• Payer & Plan Configuration
  • Build, maintain, and govern payer and plan data across workflow and pricing systems.
  • Configure and manage:
    • Submission addresses and methods (portal, fax, mail)
    • Contact information and escalation paths
    • Timely filing and payer-level attributes
  • Standardize payer and plan names, aliases, and identifiers.
• Automation & Platform Enablement
  • Maintain configuration logic that drives:
    • Workflow rules
    • Automation triggers
    • Follow-up timelines
    • Claim and appeal routing
  • Partner with Product, AI, and Engineering to enhance payer data and routing logic.
  • Maintain accurate routing across pricing, appeals, and automation workflows.
  • Analyze and resolve routing exceptions and data discrepancies.
• Data Quality & Auditing
  • Audit payer master data to ensure accuracy, completeness, and integrity.
  • Identify and resolve duplicates, mismatches, and client-specific data issues.
  • Support exception handling and review workflows for data and routing issues.
  • Apply data governance standards and naming conventions consistently.
  • Support initiatives to reduce duplicate, inactive, and inconsistent records.
• Cross-Functional & Operational Support
  • Support client onboarding, releases, and post-production issue resolution.
  • Manage a prioritized queue of configuration updates, fixes, and investigations.
  • Recommend process improvements that increase accuracy, scalability, and turnaround time.

Qualifications

• Bachelor’s degree in business, Health Information Management, or related field (or equivalent experience).
• 3+ years of experience in payer operations, data analysis, system configuration, or revenue cycle workflows.
• Strong analytical, problem-solving, and detail-oriented skills.
• Advanced Excel skills; experience with workflow, case management, or data systems preferred.

Requirements

• Experience with payer master data, plan standardization, or routing logic.
• Understanding of claim, appeal, and denial workflows.
• Experience supporting automation-enabled workflows and data-driven process improvements.
• Client onboarding or production support experience.