Payment Integrity Analytics Specialist

PacificSource; Georgia; Hybrid; USD 57,000 - 97,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical, vision, and dental insurance

401(k) plan

Tuition reimbursement and training

Job summary

PacificSource is seeking a data analytics professional to develop and maintain payment integrity dashboards, reports, and scorecards across healthcare programs. You will analyze claims data to identify opportunities and support leadership with timely, data-driven insights.

The role emphasizes collaboration with IT and data teams, compliance with HIPAA, and contributing to budgeting and forecasting for payment integrity programs.

Qualifications

• Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, or related experience.
• Bachelor's degree preferred in business, finance, statistics, data analytics, or healthcare administration.
• Strong data analysis, reporting, and MS Excel skills; familiarity with HIPAA.”],
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Responsibilities

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards.
• Track recoveries, cost avoidance, savings, inventory, and operational performance metrics.
• Analyze claims, provider, reimbursement, and audit data to identify opportunities and trends.
• Support fraud, waste, and abuse detection through data analysis and reporting.
• Monitor vendor performance and validate reported recoveries and contractual measures.
• Develop recurring operational, financial, and executive reporting.
• Perform data validation, reconciliation, and quality assurance.
• Support audit targeting, provider outlier analysis, and recovery opportunities.
• Create ad hoc analyses and presentations for leadership decisions.
• Partner with IT and enterprise data teams to improve reporting and data access.
• Identify trends, risks, and opportunities with data-driven recommendations to leadership.
• Assist with budgeting, forecasting, and performance measurement for payment integrity programs.
• Support regulatory reporting, audits, and documentation requests.
• Participate in departmental meetings and projects.

Skills

Accountability

Collaboration

Communication

Flexibility

Active Listening

Organization & Planning

Problem Solving

Teamwork

SQL

Power BI

Tableau

Education

Bachelor's degree in business/finance/data analytics/healthcare administration

High school diploma or equivalent

Tools

SQL

Power BI

Tableau

Job description

Essential Responsibilities:

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards.
• Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics.
• Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends.
• Support fraud, waste, and abuse detection efforts through data analysis and reporting.
• Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures.
• Develop recurring operational, financial, and executive reporting.
• Perform data validation, reconciliation, and quality assurance activities.
• Support audit targeting, provider outlier analysis, and recovery opportunity identification.
• Create ad hoc analyses and presentations to support leadership decision-making.
• Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility.
• Identify trends, risks, and opportunities and provide data-driven recommendations to leadership.
• Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs.
• Support regulatory reporting, audits, and documentation requests.
• Participate in departmental meetings and assigned projects.

Supporting Responsibilities:

• Participate in compliance and operational initiatives as needed.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Success Profile

• Work Experience: Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required.
• Education, Certificates, Licenses: Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred. High school diploma or equivalent required.
• Knowledge: Healthcare claims processing and reimbursement methodologies. Data analysis and reporting techniques. Microsoft Excel and reporting tools. SQL, Power BI, Tableau, or similar reporting platforms preferred. Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred. Statistical analysis and performance measurement concepts.
• Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment:
• Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range: $56,779.86 - $96,525.75

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements

• Stoop and bend.
• Sit and/or stand for extended periods of time while performing core job functions.
• Repetitive motions to include typing, sorting and filing.
• Light lifting and carrying of files and business materials.
• Ability to read and comprehend both written and spoken English.
• Communicate clearly and effectively.

Disclaimer

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

PacificSource is anything but a typical health insurance company.

Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care.

So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 525,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement.

Benefits

• Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.

We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance Stay tuned! More to come soon!

PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that.

Top Workplace 2026, 2025 and 2024 USA | USA Today 2025 Healthcare Top Workplaces | Energage Top Workplaces # 6 Healthiest Employer of Oregon 2025 | Portland Business Journal Top Workplace 2024, 2023 and 2022 for Oregon and SW Washington | The Oregonian Top Workplace 2025, 2024, 2023 and 2022 for the Treasure Valley | Idaho Press Certified Age Friendly Employer, 2023 | Age Friendly Institute PacificSource is an equal opportunity employer.