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Payment Integrity Analyst Jobs (NOW HIRING)

HMSA

Analyst, Payment Integrity

Honolulu, HI · Hybrid

* Research and Analysis * Serve as contact for external vendors and internal departments to support operations and payment integrity activities. * Research and respond to low to high priority complex ...

Bcbsa

Director, Payment Integrity

Chicago, IL · On-site

Preferred MS or MBA in Healthcare Administration, Public Health or Business Analytics Experience * Required 12+ Years Progressive Experience in healthcare payment integrity and claims operations ...

Point32Health

Director - Payment Integrity

Canton, MA · On-site

$550/day

Performance Monitoring and Analysis: Develop and implement metrics and key performance indicators (KPIs) to monitor Payment Integrity performance, including vendor management of contractual SLAs and ...

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How much do payment integrity analyst jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for payment integrity analyst in the United States is $31.53, according to ZipRecruiter salary data. Most workers in this role earn between $25.24 and $35.82 per hour, depending on experience, location, and employer.

What are the typical responsibilities of a Payment Integrity Analyst on a daily basis?

A Payment Integrity Analyst typically reviews healthcare claims for accuracy, audits processed payments to detect errors or potential fraud, and analyzes data to identify trends or recurring issues. You’ll collaborate closely with claims adjusters, medical coders, and compliance teams to resolve discrepancies and implement improvements. The role often involves preparing reports, documenting findings, and recommending solutions to streamline payment processes. This job requires strong analytical skills and effective communication as you’ll bridge the gap between raw data and actionable business decisions.

What are the key skills and qualifications needed to thrive in the Payment Integrity Analyst position, and why are they important?

To thrive as a Payment Integrity Analyst, you need strong analytical skills, attention to detail, and a background in healthcare billing, finance, or related fields. Experience with data analysis tools (such as Excel, SQL, or Tableau), healthcare claims systems, and knowledge of industry regulations or certifications like CPC or CPMA are highly valued. Strong problem-solving abilities, effective communication, and collaboration skills help analysts navigate complex data and work efficiently with cross-functional teams. These competencies are vital for accurately identifying discrepancies, optimizing payment processes, and ensuring financial accuracy within healthcare organizations.

What does a Payment Integrity Analyst do?

A Payment Integrity Analyst is responsible for reviewing healthcare claims, payments, and billing practices to identify errors, fraud, waste, or abusive billing patterns. They analyze data, conduct audits, and work with providers and internal teams to ensure compliance with healthcare regulations and payer policies. Their role helps prevent financial losses and improves the accuracy of payments in the healthcare industry.

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Payment Integrity Analyst jobs near you
Senior Data Mining & Payment Integrity Analyst

Senior Data Mining & Payment Integrity Analyst

Gainwell Technologies LLC

Austin, TX

$69K - $99K/yr

Other

Medical, Retirement, PTO

Posted 7 days ago

Gainwell Technologies rating

7.7

Company rating: 7.7 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

106th of 186 rated software companies

Job description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.
Summary
As a Senior Data Mining & Payment Integrity Analyst, you will design and develop data mining concepts that identify improper payments and improve claims accuracy across dental, medical, and pharmacy billing. Using your expertise in healthcare reimbursement, regulations, and data analysis, you will translate complex policies into scalable audit and analytics solutions. You will collaborate with cross functional teams to drive innovation, support client payment integrity strategies, and help safeguard healthcare resources for the populations our clients serve.
Your Role in Our Mission
  • Develop and implement new data mining opportunities to identify overpayments to providers through data review and analytics across dental, medical, and pharmacy claims.
  • Act as a senior member of the team and mentor lower-level analysts.
  • Research industry standard guidelines, State and Federal regulations, and client billing and reimbursement policies to develop and configure improper payment algorithms.
  • Review provider contracts to identify algorithms for the identification of contract-based overpayments.
  • Implement current Payment Analytics concepts for new and existing clients while ensuring client policy is supportive and properly applied.
  • Support the appeals, validation, and client services teams in resolving outstanding issues related to production queries.
  • Ensure individual and departmental goals are consistently met or exceeded through collaboration with other team members and management.
  • Review IT programming results for quality assurance and proof of concept validation.
  • Document query results and prepare internal and external documentation and presentations related to new overpayment issues.
  • Partner with internal operations and clinical teams to develop, implement, review, and audit protocols and internal review guidelines.
  • Collaborate with engineers to develop and implement technological improvements that support the audit process.
  • Contribute innovative ideas for improving existing audit processes and audit queries.

What We Are Looking For
  • 5 years of Healthcare Payment Integrity and/or Data Mining experience.
  • At least 3 years of Domain Specific experience in Medical, Dental, or Pharmacy claims analysis.
  • Experience in Healthcare Auditing, including Reviewing and Validating the Accuracy of Claims Data and the Accuracy of Claims Payment, is preferred.
  • Experience Applying Published Healthcare Guidelines such as CMS Regulations and Coding Guidelines to Healthcare Claims Data. Recovery audit experience is preferred.

What you should expect in this role
Opportunities to travel through your work (0-10%)
Video cameras must be used during all interviews, as well as during the initial week of orientation
The deadline to submit applications for this posting is July 30, 2026.
The pay range for this position is $69,400.00 - $99,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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About Gainwell Technologies

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With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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