Healthcare Analytics & Fraud Intelligence Analyst

Blue Cross and Blue Shield of North Carolina; Jacksonville (FL); On-site; USD 89,000 - 143,000; Full time

Job summary

Blue Cross and Blue Shield of North Carolina in Jacksonville, FL seeks a strategic analytics partner to support SIU and Payment Integrity with BI, reporting, and audit analytics. You will translate healthcare data into actionable insights to identify fraud, waste, and abuse while driving payment accuracy and operational improvements.

The role requires 3+ years in healthcare analytics, a Bachelor's degree (or higher), and strong analytical and communication skills.

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

Responsibilities

• Partner with SIU, Payment Integrity, Clinical, Finance, and operational stakeholders to identify business needs and develop analytical solutions.
• Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics solutions.
• Analyze healthcare claims, provider, member, audit, and investigation data to identify trends, anomalies, emerging risks, and opportunities for improvement.
• Develop recurring and ad hoc financial and operational reporting for leadership to measure program effectiveness and ROI.
• Design, execute, validate, and document statistically valid sampling methodologies to support provider audits and extrapolation activities.
• Collaborate with BI Analysts, Data Scientists, and others to define data requirements and improve data quality.
• Facilitate requirements gathering and stakeholder reviews to ensure value delivery.
• Validate data accuracy, reconcile outputs, and ensure consistency across systems.
• Communicate analytical findings through visualizations, presentations, and summaries.
• Establish reporting standards and governance for scalable analytical solutions.
• Manage multiple projects with proactive status updates and risk communication.

Skills

Healthcare analytics

Data visualization

Statistical methods

Communication skills

Problem solving

Education

Bachelor's degree or higher

Tools

Snowflake

AI agents

Job description

Blue Cross and Blue Shield of North Carolina in Jacksonville, FL seeks a strategic analytics partner to support SIU and Payment Integrity with BI, reporting, and audit analytics. You will translate healthcare data into actionable insights to identify fraud, waste, and abuse while driving payment accuracy and operational improvements.

The role requires 3+ years in healthcare analytics, a Bachelor's degree (or higher), and strong analytical and communication skills.