Business Data Analyst - Claims Compliance

The Data Analyst for Regulatory Compliance Reporting Analyst will compile and analyze reports for submission for the Health Plan Audits for their respective Product Lines (Commercial, Senior, and Medical) which impact 10 Health Plans. This position will support internal department reporting needs to fulfill business requirements. This role has strong interaction and collaboration across SJHH NSS and Care Integration (NSS Support Services, Claims, Claims Auditing, UM, and CM) operations. In addition, this position provides reports to a variety of customers, both internal and external on a regular basis. Reports will include UM reporting activities, Provider Dispute Resolution, Re-Opening for Senior Claims, FEHBP, Claims Inventory, Misdirected Claims, Medicare Interest Rate and Claims Pricing, MTR, Monthly NSS, Board Foundation, and Regional Report. Manage the flow of scheduled reports to ensure customer deadlines and health plan audit compliance requirements are met.

Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required qualifications:

• Associate's Degree or equivalent education/experience

• High School Diploma/GED with 2 years relevant experience in field directly related to reporting and data analysis.

• 1 year Experience compiling reports in a Healthcare related business, preferably in a health plan environment.

• 1 year Experience supporting users with reporting requirements.

• 1 year Audit and compliance experience.

• Recent experience working with Claims and Utilization Management related data.

• Experience with HIPAA Regulation and California State Law.

Preferred qualifications:

• Bachelor's Degree

• 2 years' Experience compiling reports in a Healthcare related business in a health plan environment.

• 2 years' Experience supporting users with reporting requirements.

• 2 years' Experience in a healthcare organization working with health plan or government regulations.

• 2 years' Audit and compliance experience.

• Recent experience working with Claims or Utilization Management related data in the Medicare, Medical or Commercial healthcare environment.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.