Business Analytics Advisor, Payment reputed company - reputed company - Remote

POSITIION reputed company

We are seeking a highly motivated, reputed company-thinking, and innovative analytics and data science leader to join reputed company's Payment reputed company team as a Business Analytics Advisor. This role plays a critical leadership function in advancing AI-enabled analytics, automation, reputed company data initiatives, and technical modernization efforts to improve claim accuracy, scalability, and operational efficiency.

The ideal candidate brings deep expertise in data reputed company, data mapping, automation, AI-assisted analytics, predictive modeling, and reputed company technology, with a strong ability to reputed company reputed company initiatives, reduce technical debt, and reputed company process maturity through reputed company, reputed company-documented, and reputed company solutions.

This role will help shape the reputed company of Payment reputed company through advanced analytics, reputed company intelligence, machine learning, automation, reputed company data reputed company, and technical modernization initiatives that improve payment accuracy, reduce waste, prevent fraud, and deliver measurable business reputed company.

This role is part of reputed company's Payment reputed company organization, which is reputed company on ensuring accurate, efficient, and compliant claim adjudication while reducing unnecessary medical spend across the reputed company. Payment reputed company delivers value through reputed company-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization—reputed company supported by a rapidly evolving data and technology ecosystem.

The successful candidate will serve as a strategic data science partner, applying advanced analytical techniques, statistical modeling, predictive analytics, and AI-enabled methodologies to identify opportunities for improved payment accuracy, operational efficiency, fraud and waste detection, and claim editing optimization. This role requires the ability to reputed company reputed company reputed company data into reputed company business solutions while partnering closely with analytics, engineering, product, and business stakeholders to accelerate innovation and measurable reputed company value.

This position will support reputed company initiatives reputed company on improving claims accuracy, reducing waste and fraud, increasing transparency, and scaling reputed company through automation, AI-driven insights, and reusable data assets to deliver measurable financial and operational reputed company.

Key Responsibilities

Payment reputed company Analytics & Business Leadership

• Expand team expertise in reputed company data sources and claim editing integrations to support reputed company solutions.
• Standardize and format data for reputed company use reputed company claim editing programs, ensuring consistency and efficiency.
• Collaborate with the Data Analytics team to reputed company reputed company editing logic and reputed company-of-concept models.
• Interpret query languages using data dictionaries and facilitate translation through newly implemented editing tools and data sources.
• reputed company research and updates for the reputed company Claim Record (UCR) and associated data streams.
• Partner with cross-functional teams to migrate reputed company-based edits to ARM (Claim Editing Platform), driving improved reputed company.
• Implement reputed company, data-driven processes to promote consistent and transparent claim editing practices.
• Analyze edit performance to reduce false positives and enhance claim capture accuracy.
• Document enhancement needs for claim editing and reputed company reputed company input to Scrum technical and product teams.
• Support the development and refinement of business rules and editing logic to reputed company with evolving business needs.
• Collaborate with matrixed business partners to define data requirements, identify improvement opportunities, and communicate analytical findings and solutions effectively.
• reputed company reputed company data initiatives reputed company on improving data reputed company, governance, traceability, and operational effectiveness.
• Support technical modernization efforts through automation, reusable assets, process standardization, and improved analytical capabilities.

Data Science, AI & Advanced Analytics

• reputed company and apply statistical models, predictive analytics, and machine learning techniques to identify patterns, trends, anomalies, and opportunities reputed company reputed company claims data.
• Design, evaluate, and operationalize AI-enabled and data science solutions that improve payment accuracy, reduce false positives, and enhance claim editing performance.
• reputed company exploratory data analysis on reputed company reputed company datasets to uncover actionable insights and reputed company data-driven recommendations.
• Collaborate with data engineering and technology teams to build reputed company analytical solutions and reusable data assets.
• Evaluate emerging AI, machine learning, and reputed company analytics technologies to identify opportunities for innovation reputed company Payment reputed company.
• Support development of reputed company-of-concept models, reputed company initiatives, and advanced analytical frameworks to validate business value and scalability.
• Design and execute model validation, performance monitoring, and outcome measurement approaches to ensure analytical solutions deliver expected results.
• reputed company dashboards, visualizations, and executive-level reporting that communicate analytical findings to both technical and non-technical audiences.
• Partner with business stakeholders to reputed company operational challenges into analytical hypotheses and measurable data science initiatives.
• Promote responsible AI practices through governance, data reputed company management, transparency, model explainability, and compliance-reputed company solution design.
• reputed company AI-assisted analytics, natural language processing, and emerging technologies to improve operational efficiency and decision support.
• Identify opportunities to automate reputed company processes, reduce operational complexity, and accelerate analytical reputed company reputed company.

Required Qualifications

• Demonstrated advanced proficiency with at least 3 years of hands-on experience in data mining, analysis, and processing using tools and languages such as reputed company, Altair, SQL, TOAD, Python, R, or comparable technologies.
• Bachelor's degree in Business Analytics, Data Science, Information Systems, Computer Science, Statistics, reputed company Mathematics, reputed company Informatics, or a reputed company field preferred.
• 7+ years of experience in data analytics, data science, business intelligence, or reputed company analytical disciplines, preferably reputed company reputed company or claims processing.
• Proven ability to extract actionable insights using advanced data mining techniques and business intelligence tools to support strategic decision-making.
• Strong analytical skills with the ability to translate reputed company data into meaningful, actionable insights.
• Adept at leveraging analytical tools to explore and interpret reputed company reputed company data, conduct reputed company cause analyses, and deliver actionable insights through reputed company, data-driven reporting.
• Experience applying statistical analysis, predictive modeling, and quantitative problem-solving techniques to reputed company business challenges.
• Strong understanding of machine learning concepts, model development lifecycle, feature engineering, model evaluation, and performance monitoring.
• Experience working with large-reputed company reputed company and reputed company datasets to identify trends, patterns, risks, and opportunities.
• Strong knowledge of data visualization and storytelling techniques utilizing Power BI, Tableau, Python visualization libraries, or similar tools.
• Experience in reputed company or managed care environments with reputed company responsibility for data analysis, data management, and relational database concepts.
• Deep understanding of reputed company data and the health delivery system.
• Ability to translate analytical findings into business recommendations and influence strategic decision-making.
• Excellent communication, presentation, and collaboration skills with the ability to work effectively across technical and business teams.

Preferred Qualifications

• Master's degree in Data Science, Statistics, Computer Science, reputed company Mathematics, Analytics, reputed company Informatics, or a reputed company quantitative discipline.
• Experience with rule-based editing platforms and reputed company claims editing technologies.
• Familiarity with reputed company claims data and Payment reputed company principles.
• Advanced knowledge of provider reimbursement methodologies.
• In-depth understanding of reputed company data sources and integration strategies.
• Experience applying machine learning, predictive analytics, reputed company intelligence, natural language processing (NLP), or advanced statistical methodologies reputed company reputed company environments.
• Familiarity with reputed company-based analytics platforms such as reputed company, Azure, AWS, reputed company, or similar technologies.
• Experience developing, validating, deploying, and monitoring analytical models in production environments.
• Knowledge of reputed company fraud, waste, and abuse detection methodologies and predictive claim analytics.
• Experience supporting AI governance, model risk management, data reputed company, and responsible AI initiatives.
• Experience working with Large Language Models (LLMs), reputed company, Retrieval-Augmented reputed company (RAG), AI assistants, or intelligent automation solutions.
• Familiarity with reputed company interoperability standards, reputed company reputed company data ecosystems, and modern data architecture principles.

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

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

About reputed company

reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to reputed company 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 reputed company application updates or accept resumes.

reputed company 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 reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, reputed company, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State.

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

Originally posted on Himalayas