Payor and Verification Data Analyst

Overview

The Payor Data & Verification Specialist plays a critical role in ensuring the accuracy, integrity, and reliability of payer information used across internal systems. This position focuses on maintaining high‑quality payer data, validating benefit details, and performing manual investigations to support correct payer identification on cases and claims. The ideal candidate combines strong data stewardship, analytical thinking, and effective communication with payors and cross‑functional teams.

Key Responsibilities

• Maintain and update third‑party data sources and payer logic to support accurate payer designations and plan type classification (e.g., government programs, maximizer plans, etc.).
• Develop, document, and continuously maintain comprehensive payer reference sheets covering designations, plan types, and relevant rules.
• Oversee internal payer databases, ensuring all payer and plan information adheres to strict data governance standards.
• Conduct manual benefit investigations directly with payors to clarify or confirm coverage and benefit details.
• Review and apply manual overrides to payer designations when new or corrected information becomes available, ensuring all updates are fully auditable.
• Perform internal audits using paid claims data to assess payer identification accuracy and identify opportunities for improvement.
• Collaborate with internal teams-including client services, legal, and product/IT-to streamline payer workflows and support compliance requirements.
• Prepare and deliver periodic reports on payer data quality, benefit investigation outcomes, and override trends.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Health Information Management, Data Analytics, or a related field-or equivalent experience.
• Exceptional attention to detail and strong commitment to data governance.
• Experience working with payer data, benefit investigation processes, or claims information.
• Strong communication skills for interacting directly with payors and partnering with cross‑functional internal teams.
• Ability to document workflows clearly and maintain audit‑ready records.
• Familiarity with healthcare payer terminology, government health programs, and plan designation frameworks.
• Experience with database systems and data quality tools.
• Preferred background in healthcare technology, revenue cycle operations, or a similar environment.