Remote: Senior Claims Data & Overpayment Recovery Analyst

EmblemHealth; New York (NY); Remote; USD 68,000 - 119,000; Full time

Job summary

EmblemHealth Remote position seeks a Health Care Claims Data Analyst to develop business requirements for queries that analyze vendor payment data and to leverage post-claim editing and recovery programs.

You will analyze claims, payments, and vendor data to identify overpayments, support cost containment, and drive process improvements. The role involves creating reports and dashboards with Excel, Power BI, and Tableau, collaborating with claims, finance, and vendor teams to maximize recoveries.

Qualifications

• 4–6+ years in health care, managed care, including vendor contracting/oversight
• Bachelor's degree required; additional experience may substitute for degree
• Extensive knowledge of health care provider audit methods and coding; medical records/billing
• Experience in claims business process analysis or claims payment/analysis
• Experience in hospital/managed care with focus on claims data analysis, provider contracting, or decision support
• Understanding of NYS, CMS, Medicaid reimbursement guidelines; strong problem solving and attention to detail
• Technical knowledge of health insurance claims/financial recovery/vendor oversight
• Proven ability to apply quantitative/qualitative research and data analysis to improve processes
• Experience collaborating with stakeholders to translate business needs into technical solutions (HIPAA-compliant)
• Strong understanding of data structures, relational databases, and query logic
• Excellent communication skills; ability to influence management decisions
• Experience in Continuous Improvement Management for Operations and process mapping/documentation
• Energy and passion for end-to-end excellence and customer experience
• Proficient with MS Office and data systems; SQL for data querying/analysis; Power BI/Tableau preferred
• Ability to work collaboratively with cross-functional teams
• Skilled in presenting data findings to both technical and non-technical audiences

Responsibilities

• Develop and gather business requirements for vendor payment data queries
• Analyze claims, payments, and vendor data to identify overpayments and cost containment opportunities
• Create and deliver reports and dashboards with actionable insights
• Manage vendor performance data and drive recovery improvements
• Collaborate with internal teams to implement overpayment prevention strategies
• Monitor trends and regulatory changes to ensure compliance

Skills

Communication skills

Data analysis

SQL

Data visualization

Cross-functional collaboration

Process improvement

Education

Bachelor's degree

Tools

Power BI

Tableau

Job description

EmblemHealth Remote position seeks a Health Care Claims Data Analyst to develop business requirements for queries that analyze vendor payment data and to leverage post-claim editing and recovery programs.

You will analyze claims, payments, and vendor data to identify overpayments, support cost containment, and drive process improvements. The role involves creating reports and dashboards with Excel, Power BI, and Tableau, collaborating with claims, finance, and vendor teams to maximize recoveries.