BI Analyst

Blue Cross and Blue Shield of North Carolina; Alabama; On-site; USD 89,000 - 143,000; Full time

Job summary

Blue Cross NC is seeking an analytics partner for its Special Investigations Unit and Payment Integrity teams. You will deliver actionable business intelligence, financial reporting, and operational insights to identify fraud, waste, and abuse, and to drive savings and efficiency.

You will translate complex healthcare data into meaningful insights, support audit programs, and develop statistically valid sampling methodologies for provider audits.

Qualifications

• Bachelor's degree or advanced degree (where required).
• 3+ years of experience in healthcare analytics, SIU, Payment Integrity, or a related field.
• In lieu of degree, 5+ years of experience in related field.
• Strong analytical, problem-solving, and communication skills.
• Experience supporting SIU, FWA, Payment Integrity, claims auditing, or provider payment review.
• Knowledge of healthcare claims processing and billing practices (CPT/HCPCS/ICD-10/DRG).
• Experience with sampling methodologies, confidence intervals, extrapolation, and audit analytics.
• Experience measuring healthcare savings, recoveries, cost avoidance, and performance metrics.
• Experience with Snowflake and building AI agents.

Responsibilities

• Partner with SIU, Payment Integrity, Clinical, Finance, and operations to identify business needs and analytical solutions.
• Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics.
• Analyze healthcare data to identify trends, anomalies, and opportunities for improvement.
• Develop recurring and ad hoc financial and operational reporting for leadership.
• Design and document statistically valid sampling for provider audits and extrapolation.
• Collaborate with BI Analysts and Data Scientists to define data requirements and improve data quality.
• Facilitate requirements gathering and stakeholder reviews to ensure insights deliver value.
• Validate data accuracy and reconcile outputs across systems and audiences.
• Communicate findings with visuals, presentations, and written summaries.
• Establish reporting standards, governance, and scalable development methodologies.
• Manage multiple projects with proactive status updates and risk identification.

Skills

Analytical skills

Problem solving

Communication

Education

Bachelor's degree

Advanced degree

Tools

Snowflake

AI agents

Job description

Job Description

Serves as a strategic analytics partner to the Special Investigations Unit (SIU) and Payment Integrity teams by delivering actionable business intelligence, financial reporting, operational insights, and statistically sound audit support. This role combines advanced data analysis, dashboard development, healthcare claims expertise, and stakeholder engagement to identify fraud, waste, abuse, payment accuracy opportunities, and operational improvement initiatives.

The analyst develops reporting and analytical solutions that support provider investigations, overpayment recovery efforts, prepayment and post-payment audit programs, and executive decision-making. This role is responsible for translating complex healthcare data into meaningful insights, measuring program effectiveness, supporting statistically valid sampling methodologies, and driving measurable savings and operational efficiencies across the organization.

• Partner with Special Investigations Unit (SIU), Payment Integrity, Clinical, Finance, and operational stakeholders to identify business needs and develop analytical solutions that support fraud, waste, abuse detection, payment accuracy, and operational performance management.
• Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics solutions that provide actionable insights into investigation outcomes, provider risk, savings, recoveries, cost avoidance, inventory management, and key performance indicators.
• Analyze healthcare claims, provider, member, audit, and investigation data to identify trends, anomalies, emerging risks, and opportunities for financial and operational improvement.
• Develop recurring and ad hoc financial and operational reporting used by leadership to measure program effectiveness, resource utilization, productivity, return on investment, and strategic objectives.
• Design, execute, validate, and document statistically valid random sampling methodologies to support provider audits, overpayment identification, error rate measurement, and extrapolation activities.
• Collaborate with business partners, BI Analysts, Data Scientists, and others to define data requirements, improve data quality, and operationalize advanced analytical solutions.
• Facilitate requirements gathering, solution design, and stakeholder review sessions to ensure reporting and analytical solutions meet business objectives and deliver measurable value.
• Validate data accuracy, reconcile reporting outputs, and ensure consistency of financial, operational, and analytical metrics across multiple systems and audiences.
• Communicate analytical findings, insights, risks, and recommendations to business partners and leadership through effective visualizations, presentations, and written summaries.
• Establish and maintain reporting standards, documentation, governance practices, and development methodologies to ensure scalable, reliable, and sustainable analytical solutions.
• Manage multiple projects and priorities simultaneously while proactively communicating status, risks, dependencies, and opportunities to stakeholders and leadership.

What You Bring

Required

• Bachelor's degree or advanced degree (where required)
• 3+ years of experience in healthcare analytics, SIU, Payment Integrity, or a related field
• In lieu of degree, 5+ years of experience in related field.
• Strong analytical, problem-solving, and communication skills.

Preferred

• Experience supporting Special Investigations Unit (SIU), Fraud, Waste & Abuse (FWA), Payment Integrity, claims auditing, or provider payment review functions.
• Knowledge of healthcare claims processing, reimbursement methodologies, CPT, HCPCS, ICD-10, DRG, and provider billing practices.
• Experience with statistical sampling methodologies, confidence intervals, extrapolation, and audit-related analytics.
• Experience measuring healthcare savings, recoveries, cost avoidance, and operational performance metrics.
• Experience with Snowflake
• Experience building AI agents

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00