Payment Integrity Analytics Lead

PacificSource Health Plans; Kansas City (MO); On-site; USD 57,000 - 97,000; Full time

Job summary

PacificSource Health Plans seeks a Payment Integrity Analytics Specialist to turn data into actionable insights supporting payment integrity, cost avoidance, and compliance. You will build dashboards, monitor recoveries, and analyze claims to identify opportunities while partnering with IT, Finance, and Compliance.

The role emphasizes producing recurring and ad hoc reports, supporting audits, and driving data-driven decisions across the organization.

Qualifications

• Bachelor's degree preferred in business, finance, statistics, data analytics or healthcare fields.
• Strong data analysis and reporting techniques.
• Experience with SQL, Power BI, Tableau or similar tools.
• Healthcare analytics, claims data, reimbursement processes knowledge.

Responsibilities

• Develop, maintain, and distribute payment integrity dashboards and scorecards.
• Track recoveries, savings, cost avoidance, and performance metrics.
• Analyze claims and reimbursement data to identify integrity opportunities.
• Support fraud, waste, and abuse detection through data analysis.
• Validate reported recoveries and vendor performance metrics.
• Create ad hoc analyses and presentations for leadership decisions.
• Collaborate with IT and data teams to improve reporting accessibility.
• Assist with budgeting, forecasting, and regulatory reporting.

Skills

Healthcare analytics

SQL

Power BI

Excel

Tableau

Reporting tools

Education

Bachelor's degree

Related field preferred

Tools

Power BI

Tableau

Excel

Job description

PacificSource Health Plans seeks a Payment Integrity Analytics Specialist to turn data into actionable insights supporting payment integrity, cost avoidance, and compliance. You will build dashboards, monitor recoveries, and analyze claims to identify opportunities while partnering with IT, Finance, and Compliance.

The role emphasizes producing recurring and ad hoc reports, supporting audits, and driving data-driven decisions across the organization.