Senior Medicaid Analytics Lead – Remote (Program Integrity)

Socket.dev; Kapolei (HI); Hybrid; USD 80,000 - 120,000; Full time

Job summary

BerryDunn is seeking a Senior Medicaid Analyst to apply Medicaid program expertise, healthcare analytics, and policy know-how to improve public-sector program integrity and performance. You will analyze claims, eligibility and policy data, identify risks, and translate findings into practical recommendations for decision-makers.

The role focuses on Hawaiʻi Med-QUEST program integrity initiatives and involves collaboration with cross-disciplinary teams, mentoring juniors, and contributing to

Qualifications

• Master’s degree in public health, health policy, health administration, public policy, business administration, data analytics, economics, information systems, or a related field.
• Five or more years of progressively responsible experience supporting Medicaid, health and human services, healthcare program integrity, payment integrity, public-sector healthcare operations, healthcare analytics, or related consulting work.
• Demonstrated knowledge of Medicaid program structure and operations, including experience with claims and encounters, eligibility and enrollment, provider data, managed care, reimbursement, compliance, or other core Medicaid functions.
• Demonstrated experience analyzing Medicaid or other healthcare program data to identify trends, anomalies, risks, root causes, financial impacts, or opportunities for operational and program improvement.
• Experience using data analysis, reporting, or visualization tools such as Excel, SQL, SAS, Power BI, Tableau, or comparable technologies to analyze and communicate healthcare information.
• Ability to synthesize complex data, policy, compliance, operational, and stakeholder information into clear findings, recommendations, and decision-support materials.
• Strong analytical, problem-solving, writing, documentation, and communication skills, including the ability to independently lead complex analyses while collaborating effectively across multidisciplinary teams.
• Ability to work appropriately with sensitive Medicaid, provider, member, operational personally identifiable information, and protected health information and follow applicable privacy, security, confidentiality, and HIPAA requirements.

Responsibilities

• Analyze Medicaid claims, encounter, provider, member, eligibility, financial, and program data to identify trends, anomalies, risks, improper payment indicators, and opportunities for program improvement.
• Support Medicaid program integrity, fraud, waste, and abuse, payment integrity, and third-party liability initiatives through policy and operational analysis, provider and member research, trend monitoring, and assessment of financial and program impacts.
• Evaluate Medicaid policies, business rules, program operations, workflows, and controls to identify gaps, root causes, compliance concerns, and opportunities to strengthen program effectiveness and accountability.
• Develop and interpret performance measures, reports, dashboards, analytical summaries, and other decision-support products for Medicaid leadership, program integrity teams, and project stakeholders.
• Translate complex data, policy, compliance, and operational information into clear findings, risks, recommendations, and implementation considerations for technical and non-technical audiences.
• Lead substantive analyses and workstreams; collaborate with program integrity, forensic, payment integrity, compliance, TPL, policy, data, and operational specialists; mentor junior staff; and contribute to proposals and the continued growth of BerryDunn's Medicaid services.

Skills

Analytical skills

Policy analysis

Data analysis

Communication skills

Project leadership

Education

Master’s degree in health/public policy/data analytics

Tools

Excel

SQL

SAS

Power BI

Tableau

Job description

BerryDunn is seeking a Senior Medicaid Analyst to apply Medicaid program expertise, healthcare analytics, and policy know-how to improve public-sector program integrity and performance. You will analyze claims, eligibility and policy data, identify risks, and translate findings into practical recommendations for decision-makers.

The role focuses on Hawaiʻi Med-QUEST program integrity initiatives and involves collaboration with cross-disciplinary teams, mentoring juniors, and contributing to