Claims Reporting/Data Analyst

Commonwealth Care Alliance; Boston (MA); Remote; USD 85,000 - 120,000; Full time

Job summary

A leading healthcare organization is seeking a Claims Reporting/Data Analyst to support payment integrity and claims operations in Boston. The role involves developing analytical tools and reports, collaborating across functions, and translating data into actionable insights. Ideal candidates will have a strong background in data analysis and healthcare, with excellent communication skills. This full-time position offers a remote work option and is open for applications.

Qualifications

• 3-5 years of data analysis experience, preferably in healthcare.
• Proficiency in SQL, Excel, Access, Tableau, or similar tools.
• Strong analytical and communication skills.

Responsibilities

• Develop analyses and reports to support provider contracting decisions.
• Create ad hoc analyses for claim queries and audits.
• Prepare impactful presentations for leadership and executive teams.

Skills

Data Analysis

Healthcare Reimbursement

Cross-Functional Collaboration

SQL

Excel

Tableau

Education

Bachelor’s Degree or equivalent experience

Master’s Degree

Tools

SQL

Excel

Access

Tableau

Job description

Join to apply for the Claims Reporting/Data Analyst role at Commonwealth Care Alliance.

Position Summary

Working under the direction of the SVP Claims, the Senior Data Analyst - Payment Integrity & Claims will provide routine and ad hoc analytics to support payment integrity and claim operations. This role involves developing tools and reports to monitor performance, KPIs, and vendor SLAs, facilitating decision-making, and identifying opportunities for quality improvement and cost control.

Essential Duties & Responsibilities

• Develop analyses and reports using Excel, SQL, Access, Tableau, and other tools to support provider contracting decisions.
• Create ad hoc analyses for claim queries, retraction valuation, payment policies, and audits, including developing a claim audit repository and dashboards.
• Produce provider scorecards and lead meetings to review results and trends.
• Prepare impactful presentations and materials for leadership and executive teams.
• Conduct research using regulatory and publicly available data to inform network development.
• Develop methodologies to measure initiative impacts.
• Maintain performance reports and KPI dashboards for department metrics and SLA performance.
• Support cross-functional initiatives to enhance analytical infrastructure.
• Collaborate with internal stakeholders on quality and cost-savings initiatives.
• Build partnerships across the organization to align network activities with organizational goals.
• Possess a strong background in healthcare reimbursement, provider contracting, and data analysis.
• Translate data into actionable insights and communicate effectively.
• Track vendor data including KPIs, invoice validation, and valuations.

Working Conditions

• Standard office environment, remote opportunity.

Qualifications

• Bachelor’s Degree or equivalent experience (required); Master’s Degree (desired).
• 3-5 years of data analysis experience and 3+ years in healthcare.
• Proficiency with SQL, Excel, Access, Tableau, or similar tools.
• Knowledge of claim operations, healthcare reimbursement, and provider reimbursement methodologies.
• Strong analytical, communication, and cross-functional collaboration skills.
• English language proficiency.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Industry: Hospitals and Health Care

This job is active and accepting applications.