Fraud & Payment Integrity Analytics Lead

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

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a strategic analytics partner for the Special Investigations Unit and Payment Integrity teams. You will deliver business intelligence, financial reporting, and operational insights, combining data analysis with stakeholder engagement to identify fraud, waste, abuse, and payment accuracy opportunities.

The role involves developing reporting solutions to support provider investigations, overpayment recovery, and audit programs, translating

Qualifications

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

Responsibilities

• Deliver actionable business intelligence, financial reporting, and operational insights for SIU and Payment Integrity.
• Develop dashboards, reports, and self-service analytics to support investigations and outcomes.
• Translate complex healthcare data into meaningful insights and measurable savings.

Skills

Analytical thinking

Problem solving

Communication

Education

Bachelor's degree or advanced degree

Tools

Snowflake

AI agents

Job description

Blue Cross and Blue Shield of North Carolina is seeking a strategic analytics partner for the Special Investigations Unit and Payment Integrity teams. You will deliver business intelligence, financial reporting, and operational insights, combining data analysis with stakeholder engagement to identify fraud, waste, abuse, and payment accuracy opportunities.

The role involves developing reporting solutions to support provider investigations, overpayment recovery, and audit programs, translating