Claims Data Analyst

Job Description

Job Description

We are seeking a Claims Data Analyst to join our growing team. The ideal candidate is highly organized, detail-oriented, enjoys working with data, and thrives in a fast-paced, entrepreneurial environment. This role serves as a critical bridge between Sales, Healthcare Economics, Network Strategy, and Account Management by supporting the evaluation and sale of medical provider network solutions to self-funded employers, third-party administrators, brokers, consultants, and stop-loss vendors.

In this position, you will analyze prospective clients’ historical medical claims and eligibility data to evaluate provider disruption, network discounts, repriced claim costs, geographic access, and overall network fit. You will translate complex claims data into clear findings that help internal teams and prospective clients understand the expected performance and implications of different provider network options. You will also play a key role in improving the company’s internal claims-analysis methodologies, reporting tools, and data-processing capabilities.

Roles & Responsibilities

• Analyze prospective clients’ historical medical claims, eligibility, and provider data to evaluate provider disruption, network discounts, repriced costs, geographic access, and overall network fit.

• Partner with the Technology team to develop, test, validate, and improve internal claims-analysis and reporting tools.

• Validate incoming data, identify material data-quality issues, and document assumptions or limitations affecting the analysis.

• Apply healthcare reimbursement methodologies, fee schedules, provider contract terms, and claims coding knowledge to claims repricing and network analyses.

• Review repriced claims and modeling outputs for accuracy, consistency, and reasonableness.

• Compare provider networks, reimbursement arrangements, and other market alternatives.

• Translate analytical findings into clear reports, presentations, and recommendations for Sales, brokers, consultants, TPAs, and prospective clients.

• Support prospective client meetings, RFP responses, renewals, and other sales opportunities by explaining methodologies, findings, and financial implications.

• Coordinate analytical requirements, priorities, timelines, and deliverables across Sales, Healthcare Economics, Network Strategy, Account Management, and Technology.

• Maintain and improve analytical models, reporting templates, methodologies, and internal claims-analysis tools.

• Identify opportunities to improve data processing, quality assurance, standardization, and automation.

• Support ad hoc analyses, competitive research, strategic initiatives, and stop-loss rating requests as needed.

• Protect confidential information and protected health information in accordance with company policies, HIPAA requirements, and applicable data-security standards.

• Identify updates and enhancements to current sales and healthcare economics analytics process.

• Prepare sales team for prospective client meetings with analytical results.

• Ensure analytics reports are completed timely and accurately.

• Develop and respond to request for proposals (RFPs) in coordination with the Business Development lead by due date.

• Responsiveness to Sales and other internal stakeholders, generally within 24 to 48 hours based on the urgency and complexity of the request.

Education and Qualification Requirements

• The ideal candidate will have 2-5 years’ experience in healthcare claims analysis, provider network analytics, health insurance, healthcare economics, managed care analytics, or a related field.

• Bachelor’s degree in business, finance, economics, statistics, healthcare administration, data analytics, or a related field. Equivalent relevant professional experience may be considered.

• Experience analyzing medical claims data, preferably for self-funded or ASO health plans.

• Experience with provider network disruption, claims repricing, network discount analysis, geo-access analysis, or network adequacy analysis.

• Familiarity with medical claims fields and coding systems, including CPT/HCPCS codes, DRGs, and revenue codes.

• Advanced proficiency in Microsoft Excel and experience working with large datasets.

• Working knowledge of SQL.

• Ability to identify data issues, interpret complex results, and communicate findings clearly to technical and nontechnical audiences.

• Strong organizational skills, attention to detail, and sound judgment when managing multiple deadlines and confidential information.

• Ability to exercise appropriate judgment when working with confidential data and protected health information.

Note: It’s OK if you do not meet all the above requirements! We encourage anyone with an aptitude for data analytics and systems, foundational knowledge of medical claims or health insurance, and the ability to learn complex healthcare data and reimbursement concepts are encouraged to apply.

Healthcare Highways challenges the status quo of traditional carrier networks to bring competition, flexibility, and cost efficiency to employer-sponsored healthcare. We design, manage, and operate medical provider networks, with a core focus on high-performance networks built from curated providers who meet strict quality standards and agree to negotiated rates.

We also work directly with employers to execute their network strategy, supporting domestic network management and steerage, direct contracting, and out-of-network repricing. The result is high-quality care for local employers, with lower costs for both businesses and their employees.

We foster a collaborative, innovative, and inclusive workplace where creative and analytical thinkers thrive. At Healthcare Highways, candor, integrity, and teamwork are at the core of everything we do. We invest in our employees' growth and professional development by offering competitive compensation, career advancement opportunities, and a strong commitment to work-life balance.

A career at Healthcare Highways means being part of a forward-thinking organization transforming healthcare. If you're passionate about impacting employers, providers, and the communities we serve, we invite you to join our mission. Explore opportunities and join our team today at Healthcare Highways Careers.

Company Description

Healthcare Highways challenges the status quo of traditional carrier networks to bring competition, flexibility, and cost efficiency to employer-sponsored healthcare. We design, manage, and operate medical provider networks, with a core focus on high-performance networks built from curated providers who meet strict quality standards and agree to negotiated rates.\r\n\r\nWe also work directly with employers to execute their network strategy, supporting domestic network management and steerage, direct contracting, and out-of-network repricing. The result is high-quality care for local employers, with lower costs for both businesses and their employees. \r\n\r\nWe foster a collaborative, innovative, and inclusive workplace where creative and analytical thinkers thrive. At Healthcare Highways, candor, integrity, and teamwork are at the core of everything we do. We invest in our employees' growth and professional development by offering competitive compensation, career advancement opportunities, and a strong commitment to work-life balance.\r\n\r\nA career at Healthcare Highways means being part of a forward-thinking organization transforming healthcare. If you're passionate about impacting employers, providers, and the communities we serve, we invite you to join our mission. Explore opportunities and join our team today at Healthcare Highways Careers.