The Role
Analyze healthcare claims data to support negotiations and reimbursement strategies, develop financial models, and ensure data accuracy in claims analysis.
Summary Generated by Built In
We are seeking an experienced Senior Data Analyst with a strong background in healthcare claims, payer analytics, and reimbursement models. You will play a key part in analyzing medical and pharmacy claims data to support contract negotiations, provider reimbursement strategies, and sales initiatives. You will have a deep understanding of payer systems, Medicare reimbursement structures, fee schedules, and healthcare financial models.
How you will make an impact
- Analyze medical and pharmacy claims data to identify trends, cost drivers, and opportunities for optimization.
- Support provider contracting and payer negotiations by evaluating reimbursement models, pricing structures, and fee schedules.
- Develop financial models to assess payer performance, reimbursement strategies, and cost containment opportunities.
- Collaborate with sales and contracting teams to provide data-driven insights that support growth initiatives.
- Work with Medicare, Medicaid, and commercial claims data to track reimbursement trends and regulatory changes.
- Build reports and dashboards using SQL, Python, Power BI, or Tableau to visualize key business metrics.
- Evaluate the financial impact of alternative payment models, value-based care initiatives, and provider incentives.
- Ensure data integrity and accuracy in claims analysis to support strategic decision-making.
- Partner with internal teams to streamline claims processing, payment accuracy, and operational efficiencies.
What we are looking for
- Bachelor’s or Master’s degree in Healthcare Analytics, Statistics, Finance, Data Science, or a related field.
- 3+ years of experience in healthcare claims analysis, payer analytics, or reimbursement modeling.
- Strong knowledge of Medicare and commercial payer reimbursement methodologies.
- Experience with medical and pharmacy claims data, provider fee schedules, and healthcare financial modeling.
- Proficiency in SQL, Python, R for data analysis.
- Familiarity with contract negotiations, network management, and provider relations is a plus.
- Excellent communication skills to present data-driven insights to stakeholders.
Top Skills
Power BI
Python
R
SQL
Tableau
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The Company
What We Do
Nomi Health is rebuilding healthcare with services and technology solutions that allow easy access to quality, affordable care.
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