BI Analyst

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

Benefits offered by this job

Annual Incentive Bonus*

401(k) with employer match

Paid Time Off (PTO)

Competitive health benefits and well­-

Job summary

Blue Cross and Blue Shield of North Carolina seeks a strategic analytics partner for the Special Investigations Unit and Payment Integrity teams. Deliver actionable insights from healthcare data, build dashboards, and support audit programs.

You will translate complex claims data into metrics that drive savings, cost avoidance, and operational improvements, collaborating with SIU, Finance, Clinical, and other stakeholders.

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.
• Preferred Experience supporting 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.
• Snowflake

Responsibilities

• Provide strategic analytics partnering with SIU and Payment Integrity to drive savings and operational improvements.
• Develop dashboards, scorecards, reports, and self-service analytics for leadership.
• Translate complex healthcare data into actionable insights and executive summaries.
• Collaborate with BI Analysts and Data Scientists to define data requirements and ensure data quality.
• Support provider audits, overpayment identification, and audit-related analytics.
• Establish reporting standards, governance, and scalable development methodologies.

Skills

Healthcare analytics experience

Strong analytical skills

Problem-solving

Communication skills

Experience with SIU/FWA

Claims processing knowledge

Statistical sampling

Savings and cost avoidance metrics

Experience in lieu of degree

Education

Bachelor's degree

Advanced degree

Tools

Snowflake

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.

• Annual Incentive Bonus*
• 401(k) with employer match
• Paid Time Off (PTO)
• competitive health benefits and wellness programs

*Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care - in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Location and Hybrid Flex

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.