BI Analyst

🔥 0 minutes ago

🐎 Kentucky, Louisiana, +3 more states – Remote

🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🌴 South Carolina – Remote

💵 $89.2k - $142.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📊 Business Intelligence Developer

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Partner with Special Investigations Unit (SIU), Payment Integrity, Clinical, Finance, and operational stakeholders to identify business needs and develop analytical solutions • Design, develop, and maintain dashboards, scorecards, reports, and self-service analytics solutions • Analyze healthcare claims, provider, member, audit, and investigation data to identify trends, anomalies, emerging risks, and improvement opportunities • Develop recurring and ad hoc financial and operational reporting for leadership • Design, execute, validate, and document statistically valid random sampling methodologies for provider audits, overpayment identification, error-rate measurement, and extrapolation • Collaborate with business partners, BI Analysts, and Data Scientists to define data requirements, improve data quality, and operationalize advanced analytical solutions • Facilitate requirements gathering, solution design, and stakeholder review sessions • Validate data accuracy, reconcile reporting outputs, and ensure metric consistency across systems and audiences • Communicate analytical findings, insights, risks, and recommendations through visualizations, presentations, and written summaries • Establish reporting standards, documentation, governance practices, and development methodologies • Manage multiple projects and priorities while communicating status, risks, dependencies, and opportunities

🎯 Requirements

• Bachelor's degree or advanced degree (where required) • 3+ years of experience in healthcare analytics, SIU, Payment Integrity, or a related field • In lieu of degree, 5+ years of experience in related field • Strong analytical, problem-solving, and communication skills • Experience supporting SIU, Fraud, Waste & Abuse (FWA), Payment Integrity, claims auditing, or provider payment review functions • Knowledge of healthcare claims processing, reimbursement methodologies, CPT, HCPCS, ICD-10, DRG, and provider billing practices • Experience with statistical sampling methodologies, confidence intervals, extrapolation, and audit-related analytics • Experience measuring healthcare savings, recoveries, cost avoidance, and operational performance metrics • Experience with Snowflake • Experience building AI agents • Authorization to work in the United States

🏖️ Benefits

• Annual Incentive Bonus based on annual corporate goal achievement and individual performance • 401(k) with employer match • Paid Time Off (PTO) • Competitive health benefits • Wellness programs • Reasonable accommodations for applicants with disabilities