Payment Integrity Analytics Specialist

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

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.

PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Payment Integrity Analytics Specialist is responsible for data analysis, reporting, savings measurement, recovery tracking, operational performance monitoring, and identification of payment integrity opportunities. This role develops reports, dashboards, and analytical insights that support payment integrity operations, FWA prevention efforts, vendor oversight, and operational decision-making. The Analytics Specialist works closely with Payment Integrity leadership, Claims Operations, Finance, Compliance, Information Technology, and external vendors to transform data into actionable business insights.

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.

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

AdaptabilityBuilding Customer LoyaltyBuilding Strategic Work RelationshipsBuilding TrustContinuous ImprovementContributing to Team SuccessPlanning and OrganizingWork StandardsEnvironment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.Skills:Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

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.