Healthcare Data Mining Analyst

To support healthcare payment integrity efforts, the full-time Healthcare Data Mining Analyst will analyze claims data, identify payment errors, and collaborate with technical teams to operationalize findings, all while working remotely. Key responsibilities Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise Analyze provider contracts to ensure payments align with negotiated terms and methodologies Collaborate with engineering and data science teams to translate reimbursement logic into analytical frameworks Required qualifications 2+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side Deep understanding of provider contracts, including rate structures and reimbursement methodologies Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers Proven ability to identify improper payment patterns and root causes Comfortable collaborating with technical teams to guide implementation of business logic