Payment Integrity Analyst: Data Analytics & Claims Validation

Jobtailor; Rancho Cucamonga (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking a Health Plan Claims Auditor to independently investigate data mining leads, claim errors, and overpayments. You will develop remediation actions, apply CPT/ICD-10 coding, and ensure accurate reimbursement by interpreting contracts and paying guidelines.

The role requires analyzing patterns, creating audit-ready documentation, and collaborating with clinical, IT, and provider relations teams to support health plan operations and quality programs.

Qualifications

• Bachelor’s degree in healthcare, finance, or related field required.
• 4+ years of relevant work experience in lieu of degree acceptable.
• Experience with contract interpretation (DOFR) and data analysis is essential.
• Strong understanding of CPT/ICD-10/HCPCS coding and medical billing concepts.

Responsibilities

• Investigate data mining leads, audit findings, and billing errors to identify overpayments.
• Develop remediation actions and update business rules and workflows.
• Apply coding systems and provider contracts to ensure accurate reimbursement.
• Prepare audit-ready case notes for disputes, appeals, and CART teams.
• Collaborate with clinical, IT, SIU/FWA, and provider relations teams to support health plan operations.

Skills

Data analysis

Analytical thinking

Problem-solving

Communication

Independent decision-making

Organizational skills

Education

Bachelor’s degree in healthcare, finance, or related field

4+ years of relevant work experience in lieu of degree

Tools

SQL

Microsoft Office Suite

Job description

Jobtailor is seeking a Health Plan Claims Auditor to independently investigate data mining leads, claim errors, and overpayments. You will develop remediation actions, apply CPT/ICD-10 coding, and ensure accurate reimbursement by interpreting contracts and paying guidelines.

The role requires analyzing patterns, creating audit-ready documentation, and collaborating with clinical, IT, and provider relations teams to support health plan operations and quality programs.