Senior Payment Integrity & Claims Analytics Lead

Jobtailor; Rancho Cucamonga (CA); On-site; USD 110,000 - 160,000; Full time

Job summary

Jobtailor seeks a lead-level analyst to drive payment integrity operations for health plans in California. You will QA junior analysts, lead vendor reporting, and collaborate on strategies to improve financial performance and cost containment.

The role requires five years of experience in payment integrity, claims auditing, or medical coding, with strong SQL and data visualization skills. Bachelor’s degree or equivalent experience is preferred.

Qualifications

• Five years or more in payment integrity, claims auditing, or medical coding.
• Strong data analysis and SQL querying experience.
• Experience with contract and DOFR interpretation.
• Bachelor’s degree in related field required or equivalent experience.
• Knowledge of CMS, HIPAA, DRG, ICD-10, CPT coding preferred.

Responsibilities

• Provide lead-level analyst support for daily operations of payment integrity vendors and internal programs.
• Lead reporting and tracking of vendor activity to management.
• Work with leaders to improve health plan financial performance.
• Review pre- and post-pay claims to identify improper payments and cost leakage.
• Develop audit data-mining techniques to detect irregularities and trends.
• Analyze large datasets using SQL and Excel to identify root causes.

Skills

Data Analysis

Claims Auditing

Medical Coding

SQL

Excel

Data Visualization

Billing Regulations

DRG Coding

CPT Coding

Fraud Detection

Education

Bachelor’s degree in business, health administration, or related field

4+ years of additional relevant work experience in lieu of degree

Tools

Data Visualization Tools

Audit Tracking Tools

Dashboards

Job description

Jobtailor seeks a lead-level analyst to drive payment integrity operations for health plans in California. You will QA junior analysts, lead vendor reporting, and collaborate on strategies to improve financial performance and cost containment.

The role requires five years of experience in payment integrity, claims auditing, or medical coding, with strong SQL and data visualization skills. Bachelor’s degree or equivalent experience is preferred.