Healthcare Claims Data Analyst
Job Summary
Job Description
- 2+ years of healthcare claims data experience
- Proficiency in SQL (joins, CTEs, subqueries)
- Experience with reimbursement methodologies
- Familiarity with medical codes
- Excellent communication skills
- Experience with Tableau or other BI tools
6 skills required
Job Details
At Zelis, we Get Stuff Done. So, let’s get to it!
A Little About Us
Zelis is modernizing the healthcare financial experience for all 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.
A Little About You
You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.
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
Key Responsibilities:
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
Required Skills and 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.
Education:
Bachelor’s degree in healthcare information systems, Data Science, Statistics, or a related field; or equivalent experience.
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.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.
Disclaimer
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.
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