Payment Integrity Analyst - Data Mining & Savings Reporting

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District , one of the Best Companies to Work For in New York , and an Inclusive Workplace . You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. About This Opportunity In this role you’ll use advanced data mining and analytical techniques to identify improper payments, uncover cost savings opportunities, and support accurate, compliant claims payment across our health plan and report on financial trends. The role plays a critical part in protecting healthcare affordability for our members while supporting operational and financial decision‑making across the organization. Qualifications You’ll Bring Bachelor’s degree in healthcare administration, business, data science, or a related field or 5 years of equivalent experience in healthcare billing, claims adjudication, payment integrity operations, or healthcare reimbursement analytics 3+ years of experience working with healthcare data analysis, group health business, or provider practice preferred . Strong experience analyzing large healthcare datasets using SQL or modern data tools (e.g., Snowflake, dbt, Looker, Python) Experience with claims, payment integrity, or Medical Economics, especially in Medicare Advantage and/or New York Medicaid is a plus Advanced analytical skills with the ability to interpret complex data and derive meaningful insights. Detail-oriented with a high level of precision and accuracy in handling critical data. Strong critical thinking, problem-solving, and communication skills (oral and written). Ability to work independently and collaboratively in a fast-paced, high-growth environment. Skilled at preparing clear, actionable documentation and executive-level summaries. Intermediate knowledge of local, state, and federal laws and regulations pertaining to health insurance is a plus. Your Key Responsibilities Build, maintain, and enhance data pipelines that support payment integrity and savings analysis initiatives Analyze healthcare claims data to identify improper payments, wasteful spend, and cost reduction opportunities Perform deep-dive statistical analysis, predictive modeling, and experimental design to inform business strategies and operational improvement Conduct detailed reviews of claims history, provider files, and medical reviews to identify billing irregularities and financial trends Collaborate with cross‑functional partners to quantify and report savings generated by payment integrity activities Develop and deliver actionable insights and evidence-backed referrals that reduce health insurance costs Prepare and present savings reports, trending analyses, and recommendations to stakeholders Identify and resolve data quality issues, including discrepancies or missing data Ensure all analysis and reporting complies with regulatory requirements and internal policies Where You’ll Be This is a remote position; however, candidates must reside and work in New York or Vermont. Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $69,383.00-$92,279.00 MVP's Inclusion Statement At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected] .