Senior Medical Cost Analytics Advisor

As a Senior Advisor, you will provide strategic and analytical support to the Payment Integrity team, evaluating pre- and post-payment programs, clinical coding audits, and recovery initiatives to identify opportunities for savings and improved performance. You will turn data and program results into actionable insights and business cases while partnering across Finance, Operations, Clinical, Network, Claims, Product, and vendor teams to advance enterprise affordability goals.

What You’ll Do:

• Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs.

• Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap
• Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance.
• Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials.
• Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices.
• Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution.
• Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees.
• Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools.

What You’ll Bring:

• Proven ability to translate complex analyses into actionable business insights, with clear, confident communication for senior and executive audiences.
• Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
• Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls).
• Strong collaboration and influence skills, with the ability to balance multiple priorities in a matrixed environment.
• Self-starter with a strong orientation toward continuous improvement, ownership, and impact.

Requirements:

• Bachelor’s degree or in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience
• 8+ years of progressive experience in medical cost analytics, payment integrity, financial modeling, or related fields.
• Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms).
• Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
• Experience modernizing analytics through automation and thoughtful use of AI-enabled and advanced analytics methods (e.g., predictive modeling, NLP, machine learning) where they add measurable value.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At [Employer], you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About [Employer]

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

[Employer] has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Originally posted on [Employer]