Payment Integrity Data & Insights Analyst

PacificSource Health Plans; United States; Remote; USD 57,000 - 97,000; Full time

Job summary

PacificSource Health Plans is seeking an Analytics Specialist to drive data-driven insights for payment integrity, performance monitoring, and cost optimization. You will partner with Claims Operations, Finance, Compliance, IT, and vendors to transform data into actionable insights and support enterprise decision-making.

The role emphasizes dashboards, trend analysis, and reporting across healthcare payments, with responsibilities including budgeting support and regulatory data requests.

Qualifications

• Minimum of 3 years of healthcare analytics or closely related experience.
• Bachelor’s degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred. High school diploma or equivalent required.
• Strong knowledge of Excel and reporting tools; SQL, Power BI, Tableau preferred.

Responsibilities

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards.
• 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.
• Create ad hoc analyses and presentations to support leadership decision-making.

Skills

Healthcare analytics

Data analysis

Excel

SQL

Power BI

Tableau

Education

Bachelor's degree preferred

Tools

Tableau

Job description

PacificSource Health Plans is seeking an Analytics Specialist to drive data-driven insights for payment integrity, performance monitoring, and cost optimization. You will partner with Claims Operations, Finance, Compliance, IT, and vendors to transform data into actionable insights and support enterprise decision-making.

The role emphasizes dashboards, trend analysis, and reporting across healthcare payments, with responsibilities including budgeting support and regulatory data requests.