AI Analyst, Revenue & Cost Management

2+ years of experience in a quantitative analysis role focused on healthcare finance (claims operations, reimbursement, payment integrity). Foundational experience using large-scale healthcare financial data (claims, encounters, provider networks) in a payer or related vendor setting. Proficiency in SQL for data querying and manipulation. Experience using basic statistical software (R, Python, or Excel) for data preparation. Strong understanding of the healthcare claims life cycle, CPT/HCPCS/ICD-10 coding, and claims adjudication rules (Medicare Advantage experience is a plus). Excited to support the development and validation of AI and Machine Learning tools, and translate model outputs into actionable business rules. Bachelor’s degree in Actuarial Science, Health Economics, Finance, or a related quantitative field.

Act as primary domain expert for claims data and logic, including life cycle, configuration, payment rules, and financial leakage. Collaborate with Lead AI Strategist to translate claims and financial scenarios into business logic and data features for predictive models. Audit and validate provider payments against intended rules and support the definition of scope for the internal Payment Integrity (PI) engine. Assist in data quality initiatives for risk adjustment and revenue capture, validating encounter data and NPI fulfillment. Perform root-cause analysis on payment anomalies, outliers, and claims cost trends identified by AI models to confirm financial impact and operational causes.