Healthcare Claims Analytics Analyst
Quincy, MA, US
Winner of the Best and Brightest® Companies to Work for in Boston and in the Nation by the National Association for Business Resources (NABR) for the third consecutive year
Payer Expertise, Analytics Depth, and Pipeline Responsibility
Are you passionate about using data to drive real change in healthcare? We’re looking for a Healthcare Claims Analytics Analyst to join our IT team and play a pivotal role in delivering accurate, high-quality demographic, eligibility, and claims data. In this role, you’ll bridge clinical concepts with technical expertise, transforming complex datasets into clear, actionable insights that help improve healthcare outcomes for vulnerable populations.
You’ll collaborate across teams to validate, interpret, and visualize healthcare data, ensuring integrity, compliance, and usability. From building dashboards to analyzing Medicaid and Medicare data, your work will directly inform business decisions and strengthen the quality of services we deliver.
Essential Functions & Responsibilities
- Responsible for data collection, preprocessing and exploratory analysis of complex health care datasets.
- Analyze incoming data from health plans to ensure accuracy and identify discrepancies or issues.
- Analyze and interpret healthcare claim data to support/recommend decision-making processes.
- Advanced SQL proficiency with experience writing complex queries, insightful reports, and dashboards against healthcare databases.
- Transform raw data into actionable insights that support strategic business decisions.
- Develop, maintain, and execute comprehensive QC checklists and validation frameworks to ensure data integrity.
- Create detailed mapping documentation, maintain data dictionaries, and establish standardized approaches for clinical data interpretation.
- Create, execute, and maintain ETL jobs and procedures to load, validate, and ensure the accuracy and integrity of healthcare claims and eligibility data.
- Translate data findings into clear, concise reports and presentations for stakeholders at all levels.
- Work with internal teams to enhance data processing workflows and reporting accuracy. Actively contribute innovative ideas and support ad hoc projects, including time-sensitive requests.
- Other duties as assigned.
Minimum Requirements
Education
- Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering. Equivalent experience may be considered.
Experience
- 3-5 years of experience in a Managed Care/Healthcare/Medical Insurance Claims environment, alongside in-depth knowledge of Medicaid and Medicare guidelines.
- 3-5 years of experience in business intelligence and analytics, particularly in a healthcare environment where complex data analysis and report/dashboard development are key responsibilities.
- Extensive experience with claims processing, medical terminology and coding systems.
- In-depth understanding of 835 Remittance, 837 Claim, and 834 Enrollment file formats, with proven ability to interpret, analyze, and troubleshoot EDI transaction sets for accuracy and compliance.
- Understanding of HIPAA, HITECH, and healthcare data governance requirements.
- Hands-on experience with one or more ETL tools, such as Pentaho or Alteryx, to build, execute, and support data pipelines.
- Hands-on experience in data cleaning, validation, and resolving generic problems across workflows and pipelines.
Skills & Abilities
- Understand claim payment methodologies such as Medicare, Medicaid, and Commercial Reimbursement.
- Understanding of relational databases, data relationships and joins.
- Excellent technical proficiency in tools such as ProgreSQL, and SQL Coding. Adept at queries.
- Advanced SQL proficiency with experience writing complex queries, insightful reports and dashboards against healthcare databases.
- Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.
- Proficiency in Microsoft Office Suite, including Excel and Word.
- Excellent written and verbal communication with ability to document complex mappings and present findings to varied audiences.
- Detail-oriented with the ability to work independently and as part of a team.
- Must possess a strong ability to understand business questions and translate them into analytical solutions.
- Demonstrated ability to troubleshoot complex data mapping issues and develop creative solutions for non-standard data formats.
Why Join Us
- Make a Difference: Help improve access to vital benefits and services for low-income and disabled individuals.
- Collaborative Environment: Join a supportive, mission-driven team that values your ideas.
- Professional Growth: Opportunities for learning and advancement.
- Competitive Compensation: Salary and benefits that reflect your expertise.
- Flexibility: Work remotely or in a hybrid model that fits your life.
At this time, HFI will not sponsor a new applicant for employment authorization, or offer any immigration related support for this position (i.e. H1B, F-1 OPT, F-1 STEM OPT, F-1 CPT, J-1, TN, or another type of work authorization).
Our Massachusetts based starting salary for this role ranges from $80K-$110K annually. The salary range does not reflect total compensation which includes base salary, benefits and other options.
EEO Statement
HFI is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. HFI is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. HFI will not tolerate discrimination or harassment based on any of these characteristics. HFI encourages applicants of all ages.