Data Mining Analyst

Role overview

What you'll do

• Lead pre- and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.
• Analyze provider contracts to verify payments against negotiated terms, methodologies, and payer rules.
• Translate business and reimbursement logic into analytical and automation frameworks with engineering and data science teams.
• Analyze claim-level data to find root causes of overpayments or incorrect denials and recommend corrective approaches.
• Maintain expertise on CMS and commercial payer reimbursement guidelines.
• Support quality review, concept validation, and process improvement initiatives.

What you bring

• At least 2 years of healthcare data mining or claims editing experience on the provider, payer, or vendor side.
• Deep understanding of provider contracts, rate structures, carve-outs, and reimbursement methodologies.
• Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers.
• Ability to identify improper payment patterns, root causes, and correction opportunities.
• Strong investigative and deductive reasoning; ability to connect policy, data, and contract details.
• Comfort collaborating with technical teams to guide business-logic implementation.
• Self-directed, detail-oriented, and adaptable in a fast-paced environment.

Benefits

• Medical, dental, and vision offerings; FSA/HSA; tuition reimbursement; 401(k) with company match; and health and wellness benefits.
• Flexible and trusting work environment.

Workplace

• Work from anywhere in the US; the company describes itself as digital-first.

Compensation

• Pay range is $80,000–$90,000 per year; the salary is based on candidate-specific factors including experience, skills, and certifications.