The Senior Analyst, Audit and Compliance Analytics leverages healthcare data, analytical tools, and business knowledge to support Internal Audit, Compliance Analytics, and Claims Configuration Audit initiatives. This role partners with cross-functional teams to identify risks, evaluate controls, analyze claims and configuration data, and develop reporting that supports operational excellence, compliance, and payment accuracy. The individual will work on strategic initiatives with visibility across the organization and contribute to data-driven decision making. Duties and Responsibilities: Analyze complex healthcare datasets to identify trends, anomalies, control gaps, and potential compliance or operational risks. Support Internal Audit, Compliance, and Claims Configuration Audit activities through data analysis, audit testing, monitoring, and reporting. Develop advanced SQL, SAS, or other analytical queries to extract, validate, and analyze data from multiple sources. Evaluate data quality and standardize data structures to support consistent reporting and analysis. Create and maintain dashboards, scorecards, reports, and monitoring tools that provide actionable insights to leadership and business stakeholders. Summarize findings, methodologies, and recommendations for technical and non-technical audiences. Assist in the validation of claims configuration changes, business rules, and operational controls. Document analytical processes, data issues, methodologies, and business requirements. Collaborate with Internal Audit, Compliance, Claims Operations, Configuration, IT, and other business partners. Demonstrate intellectual curiosity and identify opportunities for process, control, and reporting improvements. Additional duties as assigned. Minimum Qualifications: Bachelor’s degree from an accredited institution or equivalent work experience 3+ years of equivalent experience Proficiency in scripting and programming skills Experience using MS Office suite, including Microsoft Access, Excel, and Word Expertise in utilizing data analysis and query tools such as SQL Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms Experience with applied statistics skills, such as distributions, statistical testing, regression, etc. Ability to successfully run queries from a data warehouse Expertise innovating and implementing audit techniques Excellent communication skills Excellent time management and the ability to prioritize work and complete assignments within their allotted deadline Experience working with and communicating technical information to multiple levels of technical and non-technical staff in written and verbal form Experience prioritizing a heavy workload in a fast-paced environment Preferred Qualifications: Master’s degree from an accredited institution Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration Experience with analytical programming techniques such as Python and R Experience with AWS and analytical solutions available on the platform (Redshift, Glue, Sage Maker, etc.) Familiarity with programming in JavaScript, D3.js Familiarity with big data technologies, such as Hadoop, MapReduce, and AWS Kinesis Demonstrated ability to develop innovative solutions to complex problems, leveraging advanced problem-solving skills and sound judgment to make critical, independent decisions within area of responsibility Knowledge of modern machine learning algorithms (clustering, classification and regression), statistical methods and optimization Knowledge of health care industry, systems, business strategies and products WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360 All Other Locations (within approved locations): $73,400 - $109,225 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you. Click here to navigate back to the career site!

Sr Data Analyst, Healthcare Claims Audit and Compliance (Hybrid NY).

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