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Job Description
Blue Cross NC is seeking a Senior Business Intelligence Analyst to join the Medical Economics team, with a primary focus on Payment Integrity analytics. This role will be responsible for developing advanced analyses that identify cost leakage, inappropriate utilization, coding anomalies, and payment errors across medical and pharmacy claims.
In this role you will combine your strong technical BI skills, deep healthcare claims knowledge, and your ability to translate complex findings into actionable insights for clinical, operations, and executive stakeholders.
What You Will Do Payment Integrity & Medical Economics Analytics
Leadendtoend analytical supportfor Payment Integrity programs, including: Prepay and postpay claims reviews Coding intensity and DRG shift analysis E&M level distribution and complexity migration Quantifyfinancial opportunity (PMPM and total impact)associated with PI findings and track realized savings. Partner with PI operations, SIU, RCM, and vendor teams toprioritize interventionsbased on economic value and feasibility.
Data Analysis & BI Development
Develop and maintaindashboards, reports, and analytical modelsusing claims, eligibility, provider, and benchmark data. Performtrend analysis, benchmarking, and peer comparisonsto identify outliers and emerging risk areas. Designrepeatable, scalable analytical frameworksto support ongoing monitoring of PI performance.
Stakeholder Engagement & Storytelling
Translate analytical findings intoclear, concise narrativesfor leadership, including Medical Economics, Finance, Network, and Clinical partners. Supportexecutivelevel presentationswith wellstructured insights, visuals, and recommendations. Serve as athought partnerto PI leadership in shaping strategy, measurement, and roadmap development.
Data Governance & Quality
Ensure analytical outputs areaccurate, reproducible, and alignedwith enterprise data definitions. Partner with data engineering and enterprise analytics teams to improvedata availability, reliability, and performance.
What You Bring
* Bachelor's degree or advanced degree (where required) * 5+ years of experience in related field. * In lieu of degree, 7+ years of experience in related field. Strong working knowledge ofmedical claims data, including:
CPT, HCPCS, ICD10, DRG, E&M coding Facility vs. professional claims Advanced proficiency inSQLand experience with large healthcare datasets. Strong experience withBI and visualization tools(e.g., Power BI, Tableau, Looker). Demonstrated ability to quantifycost of care and savings opportunitiesin PMPM and total dollars
Preferred Qualifications
Experience supportingPayment Integrity, FWA, or RCM functionsat a health plan or payerfocused consulting firm. Familiarity withexternal benchmarks(e.g., Milliman, BHI, CMS, HEDISadjacent measures). Experience working withvendorbased PI programsand validating vendor findings. Working knowledge ofPython or Rfor advanced analytics (a plus). Prior experience in aBlue plan or large regional payerenvironment.
#LI-Hybrid Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $98,092.00 - $156,947.00
Skills _____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
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Blue Cross and Blue Shield of North Carolina
$98,092.00 - $156,947.00
paid time off, 401(k)
Mar 04, 2026