Healthcare Claims Data Analyst

undefined ago • 2 Years + • Data Analysis

Job Summary

Job Description

We are seeking a detail-oriented and technically skilled analyst to support healthcare claims repricing and data validation efforts. In this role, you will be responsible for analyzing claims processed through our modeling systems, validating pricing accuracy across Medicare, Medicaid, and commercial reimbursement methodologies, and supporting client-facing teams with data-driven insights. Success in this role requires deep familiarity with healthcare claims data, strong SQL proficiency, and a solid understanding of reimbursement structures—including CPT, DRG, and Revenue Codes. You will work closely with internal teams and external stakeholders to resolve data issues, deliver custom reports, and ensure modeling accuracy. This is a hands-on analytical role that blends technical depth with healthcare domain expertise.
Must have:
  • Analyze repriced healthcare claims and validate outputs from modeling systems.
  • Write advanced SQL queries (joins, CTEs, subqueries) to extract, manipulate, and audit claim data.
  • Evaluate pricing scenarios based on Medicare, Medicaid, and commercial reimbursement rules.
  • Apply working knowledge of CPT codes, DRGs, and Revenue Codes in day-to-day analysis.
  • Support client-facing teams by investigating pricing questions and delivering clear, actionable insights.
  • Produce ad hoc reports and summaries for internal and external stakeholders using Excel or Tableau.
  • Collaborate cross-functionally to ensure proper scenario setup and accurate claims processing.
  • Proactively identify anomalies, root causes, and areas for process improvement.
  • Bachelor’s degree in healthcare information systems, Data Science, Statistics, or a related field; or equivalent experience.
  • 2+ years of experience working with healthcare claims data, preferably in a payer or analytics environment.
  • Strong proficiency in SQL (joins, CTEs, subqueries) is required.
  • Hands-on experience with Medicare, Medicaid, and Commercial reimbursement methodologies.
  • Familiarity with CPT codes, DRG, and Revenue Codes is essential.
Good to have:
  • Experience with Tableau or other BI tools
Perks:
  • Hybrid and remote friendly culture

Job Details

Position Overview

We are seeking a detail-oriented and technically skilled analyst to support healthcare claims repricing and data validation efforts. In this role, you will be responsible for analyzing claims processed through our modeling systems, validating pricing accuracy across Medicare, Medicaid, and commercial reimbursement methodologies, and supporting client-facing teams with data-driven insights.

Success in this role requires deep familiarity with healthcare claims data, strong SQL proficiency, and a solid understanding of reimbursement structures—including CPT, DRG, and Revenue Codes. You will work closely with internal teams and external stakeholders to resolve data issues, deliver custom reports, and ensure modeling accuracy. This is a hands-on analytical role that blends technical depth with healthcare domain expertise.

What You’ll Do:

  • Analyze repriced healthcare claims and validate outputs from modeling systems.
  • Write advanced SQL queries (joins, CTEs, subqueries) to extract, manipulate, and audit claim data.
  • Evaluate pricing scenarios based on Medicare, Medicaid, and commercial reimbursement rules.
  • Apply working knowledge of CPT codes, DRGs, and Revenue Codes in day-to-day analysis.
  • Support client-facing teams by investigating pricing questions and delivering clear, actionable insights.
  • Produce ad hoc reports and summaries for internal and external stakeholders using Excel or Tableau.
  • Collaborate cross-functionally to ensure proper scenario setup and accurate claims processing.
  • Proactively identify anomalies, root causes, and areas for process improvement.

What You’ll Bring to Zelis:

  • Bachelor’s degree in healthcare information systems, Data Science, Statistics, or a related field; or equivalent experience.
  • 2+ years of experience working with healthcare claims data, preferably in a payer or analytics environment.
  • Strong proficiency in SQL (joins, CTEs, subqueries) is required.
  • Hands-on experience with Medicare, Medicaid, and Commercial reimbursement methodologies.
  • Familiarity with CPT codes, DRG, and Revenue Codes is essential.
  • Excellent communication skills, with the ability to explain complex data issues to non-technical audiences.
  • Proficient in Excel; experience with Tableau or other BI tools is a plus.
  • Highly organized, self-motivated, and comfortable working in a fast-paced, deadline-driven environment.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Similar Jobs

quience - Data Scientist, ML - Storefront

quience

Palo Alto, California, United States (On-Site)
3 Months ago
Airbyte - Solutions Engineer

Airbyte

New York, New York, United States (On-Site)
3 Months ago
Enphase Energy - EVSE - Sr. Software Backend Engineer

Enphase Energy

Bengaluru, Karnataka, India (On-Site)
2 Months ago
Flow - Senior / Staff Data Engineer

Flow

New York, New York, United States (On-Site)
3 Months ago
Redhorse Corp - Software Engineer - Big Data Ingestion and Processing

Redhorse Corp

Herndon, Virginia, United States (On-Site)
2 Months ago

Get notifed when new similar jobs are uploaded

Similar Skill Jobs

Britive - Senior Software Engineer (Cloud)

Britive

Bengaluru, Karnataka, India (Remote)
2 Months ago
Ziff Davis - Data Scientist

Ziff Davis

Dublin, County Dublin, Ireland (Remote)
2 Months ago
Adyen - Engineering Manager - NoSQL Datastores

Adyen

Amsterdam, North Holland, Netherlands (On-Site)
2 Months ago
Workato - Senior Software Engineer (Rust)

Workato

Lisbon, Lisbon, Portugal (Remote)
2 Months ago
Insight Software - Senior Consultant Technical - ETL + SQL Expertise

Insight Software

Hyderabad, Telangana, India (Hybrid)
4 Months ago
Guardian - Engineer (Java)

Guardian

Gurugram, Haryana, India (On-Site)
3 Months ago
Version1 - Technical Architect

Version1

Belfast, Northern Ireland, United Kingdom (On-Site)
2 Months ago
Next Level Business Services - Java Developer (Full Time)

Next Level Business Services

Cincinnati, Ohio, United States (On-Site)
9 Months ago
CData - Software Development Engineer III

CData

Bengaluru, Karnataka, India (On-Site)
3 Months ago
Hitachi - Data Science

Hitachi

Pune, Maharashtra, India (On-Site)
9 Months ago

Get notifed when new similar jobs are uploaded

Jobs in Texas, United States

Riot Games - Principal Concept Artist (Characters)

Riot Games

Los Angeles, California, United States (On-Site)
3 Months ago
Intel  - Signal Integrity Engineer

Intel

Folsom, California, United States (Hybrid)
3 Months ago
Mozilla - Staff Security Engineer

Mozilla

United States (Remote)
2 Months ago
CharacterAI - Staff Data Engineer, Analytics

CharacterAI

New York, New York, United States (On-Site)
3 Months ago
WebTech Corporation - CNC Machinist

WebTech Corporation

Export, Pennsylvania, United States (On-Site)
3 Months ago
Glean - Sales Development Representative

Glean

New York, United States (Hybrid)
2 Months ago
bytedance - Software Engineer - Compute Infrastructure (Orchestration & Scheduling)

bytedance

San Jose, California, United States (On-Site)
4 Months ago
Visa - Director – Business Development Executive Corporate Sales

Visa

Ashburn, Virginia, United States (Hybrid)
2 Months ago
Outbrain - Customer Success Manager, Direct Response

Outbrain

New York, New York, United States (Hybrid)
2 Months ago
Reddit - Senior Software Engineer, Security Partner

Reddit

Seattle, Washington, United States (On-Site)
2 Months ago

Get notifed when new similar jobs are uploaded

Data Analysis Jobs

Looks like we're out of matches

Set up an alert and we'll send you similar jobs the moment they appear!

About The Company

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

St. Louis, Missouri, United States (Remote)

St. Petersburg, Florida, United States (Remote)

Texas, United States (Remote)

Plano, Texas, United States (Remote)

Hyderabad, Telangana, India (On-Site)

Hyderabad, Telangana, India (On-Site)

Hyderabad, Telangana, India (On-Site)

St. Petersburg, Florida, United States (On-Site)

View All Jobs

Get notified when new jobs are added by Zelis

Level Up Your Career in Game Development!

Transform Your Passion into Profession with Our Comprehensive Courses for Aspiring Game Developers.

Job Common Plug