Medicaid Claims Data & Integrity Analyst

Socket.dev; Kapolei (HI); On-site; USD 95,000 - 120,000; Full time

Job summary

BerryDunn is seeking a Claims Data Analyst for Hawaiʻi MQD to support FWA, program integrity, audit, and TPL activities. You will analyze Medicaid claims and related data, develop reports and dashboards, validate data quality, and communicate results to leadership.

The role involves travel up to 25% and requires collaboration with multiple teams to support monitoring, issue tracking, and documentation across payment integrity and program integrity initiatives.

Qualifications

• Experience collecting, analyzing, validating, and interpreting data to support business, operational, compliance, or program integrity objectives.
• Experience analyzing healthcare, Medicaid, claims, billing, audit, compliance, payment integrity, or government program data.
• Strong data analysis, reporting, dashboarding, SQL, statistical, visualization, or related analytical skills.
• Experience translating data findings into practical insights, operational recommendations, compliance considerations, monitoring approaches, or review priorities.
• Experience coordinating with payment integrity, audit, TPL, program integrity, operations, policy, compliance, vendor, and project leadership teams.

Responsibilities

• Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to identify trends, risks, anomalies, billing patterns, and opportunities for operational improvement.
• Support the Payment Integrity SME by preparing data summaries, dashboards, monitoring tools, reports, and decision-support products for payment integrity, claims audit, FWA, TPL, corrective action, and operational improvement activities.
• Conduct high-level Medicaid systems and claims data research related to billing codes, benefit groups, service limits, system configuration, requirements, electronic billing standards, and claims adjudication considerations.
• Assist with claims review and audit activities by validating data for accuracy, completeness, reasonableness, and alignment with Medicaid policies, program rules, and payment integrity priorities.
• Collaborate with cross-functional teams to support reporting, monitoring, data validation, and review prioritization activities.

Skills

Data analysis

SQL

Dashboarding

Data visualization

Communication

Attention to detail

Education

Bachelor’s degree preferred

Tools

Jira

Microsoft Office

AI tools

Job description

BerryDunn is seeking a Claims Data Analyst for Hawaiʻi MQD to support FWA, program integrity, audit, and TPL activities. You will analyze Medicaid claims and related data, develop reports and dashboards, validate data quality, and communicate results to leadership.

The role involves travel up to 25% and requires collaboration with multiple teams to support monitoring, issue tracking, and documentation across payment integrity and program integrity initiatives.