Claims Analyst

Role & responsibilities

• Analyze healthcare claims data to identify utilization trends, cost drivers, and provider performance metrics.
• Perform data validation and quality checks on claims data from multiple sources (e.g. TPAs, providers).
• Develop dashboards and reports to present actionable insights to stakeholders using tools like Tableau, Power BI, or similar.
• Collaborate with cross-functional teams (e.g., underwriting, provider networks, actuarial, medical management) to support strategic and operational initiatives.
• Identify fraudulent, wasteful, or abusive billing patterns and recommend corrective actions.
• Assist in the development of predictive models for risk scoring, disease management, and cost forecasting.
• Build insights based on available datasets, present to management

Generating periodic analytical reports, automate existing reports

Preferred candidate profile

Ability to understand data in the business context, Problem Solving, Soft Skills, Collaborating & Result Oriented and Able to quickly pick up and execute business requirements

Masters degree in Health Informatics, Data Science, Statistics, Public Health, or related field.

CA/MBA in finance, technology, Data Mining or Data Analysis.

Experience in Insurance domain

3+ years of experience in healthcare claims analytics or health insurance data analysis.

Total experience 4-7 years