We are seeking a skilled and detail-oriented Health Plan Claims Business Intelligence (BI) and Data Reporting Analyst to join our team. This is a remote, 4 month contract working PST hours. This role is focused on analyzing claims data, generating actionable insights, and delivering comprehensive reports to improve claims processing and operational efficiency. Using advanced analytics, data visualization tools, and business intelligence methodologies, the analyst will support the health plan in optimizing claims management processes and ensuring compliance with industry standards. The ideal candidate will have strong analytical skills, project management experience, and data modeling expertise. This role also requires collaboration with internal teams and external providers to maintain data integrity, ensure regulatory compliance, and produce monthly dashboards and recurring reports.

Key Responsibilities:

• Claims Data Analysis: Analyze healthcare claims data to identify trends, anomalies, and areas for improvement. Use statistical and business intelligence tools to enhance the efficiency of claims processing and payment integrity, while monitoring key performance indicators (KPIs) related to accuracy, timeliness, and cost.
• Business Intelligence & Reporting: Design, develop, and maintain dashboards and reports for stakeholders in claims, finance, and compliance. Leverage BI tools like Tableau, Power BI, SQL, and Excel to deliver user-friendly visualizations.Data Integrity & Compliance: Conduct routine audits and validations to ensure claims data accuracy, and ensure alignment with regulatory standards (CMS, HIPAA). Support claims audits and external reporting.Process Improvement: Collaborate with operations teams to identify and implement process improvements in claims adjudication, reimbursement, and payment processing. Use data insights to reduce claim denials and enhance provider reimbursement.Collaboration & Support: Work with IT, finance, and compliance teams to support data requests and facilitate reporting. Train end-users on interpreting claims data and using BI tools.

Key Requirements:

• Experience with claims, EDI, eligibility, benefits, and provider data.
• Proficiency with EPIC Tapestry and business intelligence tools.
• Familiarity with healthcare coding systems (ICD-10, CPT, DRG), claims adjudication, and payment integrity.
• Strong knowledge of regulatory standards and compliance requirements for claims.
• Expertise in data analysis tools such as Excel and SQL.
• Excellent problem-solving, communication, and organizational skills.
• Education: Bachelor’s degree or equivalent in a healthcare-related field.
• 5-7+ years of experience in claims, provider, and financial data management within a managed care setting.
• Data visualization, business intelligence, regulatory compliance, and claims processing knowledge.