Claims Data Strategy Lead

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SmartLight Analytics

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2016

⚕️ Healthcare Insurance

💳 Fintech

Healthcare Insurance • Fintech • Data Services

SmartLight Analytics is a healthcare analytics company that provides independent and ongoing monitoring of employee healthcare claims data. They focus on identifying and eliminating wasteful spending within health plans, ultimately lowering healthcare costs for self-funded employers without requiring changes in employee behavior. With a team of experts in data analysis, healthcare, and fraud investigation, SmartLight Analytics aims to improve healthcare benefits and promote high-value care for its clients while ensuring compliance with healthcare regulations.

📋 Description

• Own and drive end‑to‑end solutions across healthcare claims data initiatives, from problem definition through implementation and validation. • Serve as a senior authority on medical, pharmacy, behavioral health, dental, DME, and ancillary claims data. • Design, build, and optimize advanced SQL‑based data models, views, and automation frameworks with a focus on performance, scalability, and maintainability. • Develop and maintain complex claim adjustment sequencing and disposition logic, including support for split claims and multiple, disparate source configurations. • Build utilization metrics tied directly to underlying service‑level data, including inpatient, outpatient, professional, and behavioral health levels of care. • Apply deep expertise in healthcare transactions and standards, including 837, 834, 820, HL7, and CCDA, to ensure data accuracy and analytical integrity. • Proactively identify data gaps, risks, and improvement opportunities and drive them to resolution without waiting for direction. • Partner closely with product, analytics, engineering, and leadership teams to ensure claims data assets support broader business and client goals.

🎯 Requirements

• Bachelor’s degree in Computer Science, Information Systems, or related field (or equivalent practical experience) • 7-10 years of experience working with healthcare data, with deep specialization in claims data and analytics • Expert‑level proficiency in SQL and advanced query development across large, complex datasets • Extensive experience building and optimizing complex data models, views, and automation frameworks within SQL platforms • Strong understanding of healthcare claims data structures, including medical, pharmacy, behavioral health, and ancillary claims • Demonstrated ability to develop and maintain complex claim adjustment sequencing and disposition logic • Proven ability to independently assess unfamiliar data environments and rapidly develop working solutions • Strong analytical, problem‑solving, and critical‑thinking skills • Excellent communication and collaboration abilities across technical and non‑technical stakeholders • Ability to work independently, take full ownership of initiatives, and manage multiple priorities with minimal oversight.

🏖️ Benefits

• Health insurance • Professional development opportunities