Job Summary:
In this role, you will develop analytical insights to identify payment anomalies in client’s healthcare claims data.  To be successful in the role, you will have sound knowledge and experience with Statistical Models, Data Mining and building dashboards to deliver insights, insights communication and presentation, as well as demonstrating the ability to combine advanced analytics skills with exceptional business acumen. The Data Analyst II will collaborate with cross-functional teams to translate complex data findings into clear, concise and actionable recommendations.

This position is only eligible for legal residents of the United States of America

Key Responsibilities:

Data Analysis and Interpretation:

• Develop a deep understanding of the key initiative of the organization and be able to provide analytical solutions that provides actionable recommendations to drive the success of the key initiatives
• On-going monitoring of product lines including but not limited to the success metrics for each model and dashboards required for executive decision-making
• Collect, clean, and analyze data from multiple sources to identify trends, patterns and insights
• Apply statistical methods and advanced analytical techniques to solve business challenges and provide forecasts or predictive models
• Monitor data integrity by conducting regular audits and ensuring accuracy and completeness of datasets

Data Visualization and Reporting:

• Develop dashboards using claims and eligibility data with analytical insights to assist in executive decision making
• Work with business stakeholders to understand their goals, challenges and opportunities, and translate their needs into analytical projects
• Prepare on-demand analyses and ad-hoc reports and insights
• Present findings to stakeholders and translate insights into strategic recommendations

Development and Testing:

• Identify opportunities to automate data processes, streamline workflows and improve reporting efficiency
• Document analytical methodologies, data workflows and insights to ensure transparency and knowledge sharing across the organization

Business Partner Collaboration:

• Communicate analytical findings and recommendations in a clear and concise way to non-technical audiences, both in oral and written presentations
• Work closely with Information Management teams to automate recurring tasks and improve processes to continually increase efficiency

Qualifications: 

Education:

• Bachelor’s degree such as business, economics, finance or related field 

Experience:

• A minimum of three years of analytical work experience with healthcare claims data
• Experience and understanding of data analysis and appropriate application of these capabilities in a business performance environment
• SQL: 2-3 years (Required)
• Healthcare claims: 2-3 years (Required)
•  

Technical Skills:

• Proficiency in SQL and experience with data querying and database management
• Experience with data visualization tools such as Tableau, Power BI or QlikView
• Familiarity with statistical software or programming languages (e.g., R, Python, SAS or SPSS)
• Working knowledge of ETL processes and data pipelines

Key Competencies:

• Demonstrated ability to analyze data and synthesize findings into clear insights
• Experience with statistical analysis, forecasting, regression models and predictive analysis
• Strong attention to detail and a commitment to accuracy
• Proven ability to work independently and collaboratively in a fast-paced, team-oriented environment
• Curiosity, adaptability and eagerness to learn and apply new technologies or methods
• Strong written and verbal communication skills
• Ability to present complex information in a clear, concise and actionable manner

This job description serves as a general overview of the role and is not exhaustive. The Data Analyst II may be required to perform additional responsibilities as needed to support the organization’s goals and objectives.

Who is SmartLight Analytics:
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary:
The Director of Engineering will be experienced and innovative and is critical in helping to drive the growth and scalability of our technology organization as we continue to build a cutting-edge product in the healthcare data space. Reporting directly to the CTO, you will lead our engineering teams, spearheading technical strategy, execution and delivery of product development. A deep understanding of healthcare claims data is essential for this position.

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Key Responsibilities:
Leadership and Development:

• Build, scale and mentor a high-performing engineering team to meet product roadmap and strategic goals
• Implement best practices for team operations, including agile methodologies, code quality standards and development processes
• Foster a collaborative, supportive and innovative engineering culture
• Develop career growth paths for engineers, fostering talent and ensuring skill development aligns with company needs

Technical Strategy and Execution:

• Collaborate closely with the CTO to define and implement the technical vision and engineering roadmap
• Lead the team in designing, building and delivering scalable, high-quality software solutions
• Ensure alignment between technical decisions and business objectives, focusing on product scalability, stability and performance
• Work cross-functionally with product, data science, operations and other teams to drive successful execution and launch of new features and products

Product and System Architecture:

• Provide technical leadership in architecture design and code reviews, particularly around integration with healthcare claims data and data warehousing
• Oversee and enhance the reliability, security and performance of our technology infrastructure

Innovation and Continuous Improvement:

• Continuously assess emerging technologies and industry trends to keep the engineering team ahead of the curve
• Drive innovation in the engineering processes, tools and technologies to increase productivity and product quality
• Act as a champion for data-driven decision-making and efficient software development methodologies

Healthcare Claims Data Expertise:

• Provide subject matter expertise on healthcare claims data, guiding teams on how best to handle, process and leverage it
• Ensure compliance with industry standards and regulatory requirements around data privacy and security
• Collaborate with product and data teams to optimize data structures and processing methods for healthcare claims data

Qualifications:
Education:
Required bachelor’s degree in computer science, engineering, mathematics, information systems or related field  

Experience:

• 10+ years of data warehousing, applications development, data analytics experience
• 5+ years in a leadership role within a technology company, healthcare claims experience preferred

Technical Skills:

• Extensive experience working with healthcare claims data, understanding data structures, data processing
• Strong proficiency in programming languages and frameworks commonly used in healthcare technology, data engineering and ETL processes

Leadership Skills:
Proven track record of building, leading and scaling engineering teams, ideally in a startup or fast-growing company.

Strategic Vision:
Ability to align technical decisions with business goals, influencing both engineering and business strategies.

Communication:
Excellent communication skills with the ability to engage technical and non-technical stakeholders effectively.

Preferred Qualifications:

• Previous experience working directly with healthcare data warehousing solutions or healthcare data interoperability.
• Familiarity with modern data architecture approaches, including cloud platforms (e.g., AWS, Azure) and big data solutions.
• Any certifications such as Certified Scrum Master (CSM) or other Agile certifications and/or Certified Solutions Architect

Key Competencies:

• Ability to drive change and implement process improvements based on data insights
• Excellent interpersonal and communication skills, with the ability to work with cross-functional teams and external partners
• High attention to detail and a commitment to quality and compliance
• A proactive, solution-oriented approach to addressing challenges and improving operational efficiency

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary
The Carrier Relations Analyst will play a key role in managing relationships with carrier partners and analyzing data to optimize carrier performance for a data analytics company. This role will involve leveraging data-driven insights to enhance the efficiency, cost-effectiveness and reliability of carrier networks, ensuring smooth operations between the company and its partners. The ideal candidate will have strong analytical skills, a deep understanding of telecommunications and logistics operations and excellent communication abilities to foster productive relationships with carrier partners.

This position is only eligible for legal residents of the United States of America.

Key Responsibilities

• Carrier Management
  • Develop and maintain relationships with key carrier partners, acting as the main point of contact for day-to-day operations
  • Collaborate with carriers to negotiate rates, resolve issues and manage service level agreements (SLAs)
  • Monitor and evaluate carrier performance against agreed KPIs, addressing any issues that may arise
• Data Analytics & Reporting
  • Analyze carrier performance data, including delivery metrics, cost efficiency and other operational metrics
  • Create regular reports and dashboards for internal teams to track carrier performance and identify opportunities for optimization
  • Conduct trend analysis to predict potential issues with carrier performance and suggest proactive solutions
• Contract and Pricing Analysis
  • Perform cost-benefit analysis on carrier proposals, providing recommendations based on data insights
• Process Improvement
  • Identify opportunities for process optimization within the carrier management function.
  • Work closely with internal teams (operations, IT, finance, etc.) to implement improvements in the carrier management process
• Market Research
  • Stay informed about industry trends, including changes in regulations, technology advancements and carrier offerings
  • Conduct competitive analysis to understand how external factors may affect the company’s relationship with carriers

Qualifications

• Education & Experience
  • Preferred Bachelor’s degree in a health-related field
  • 4-6 years of experience in carrier relations or a data-driven role
• Technical Skills
  • Proficiency in data analytics tools (Excel, SQL, Tableau, Power BI, etc.) to analyze and visualize carrier data
  • Strong understanding of telecommunications operations, logistics or freight services.
  • Experience with contract management and pricing models is a plus
• Soft Skills
  • Strong interpersonal skills with the ability to manage relationships with external partners
  • Excellent communication skills, both written and verbal, for report writing and presentations
  • Strong analytical thinking with a problem-solving mindset and attention to detail

Key Competencies

• Analytical Ability: Ability to analyze large sets of data to uncover insights and trends related to carrier performance
• Negotiation Skills: Proven ability to negotiate favorable terms with external partners and manage contractual obligations
• Project Management: Ability to manage multiple carrier accounts and related tasks simultaneously
• Collaboration: Ability to work cross-functionally with various internal teams (IT, finance, operations) to improve carrier-related processes

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary  
As a Clinical Analyst at SmartLight Analytics, you will play a critical role in analyzing and interpreting healthcare data to provide actionable insights for improving patient outcomes, optimizing clinical workflows and supporting healthcare decision-making. Our Clinical Analysts are dedicated to identifying, investigating, reporting on and eliminating healthcare fraud and other types of wasteful spend. This position is responsible for using medical coding knowledge, prior SIU/Payment Integrity experience and critical thinking to determine if a pattern of billing is suspect or if a claim is paid incorrectly. The company uses a customized web-portal tool to access claims data. The preferred candidate would be local to the Dallas, Texas area; however, this position is a hybrid position, and a qualified candidate can work remotely with periodic travel to the office. Timely quality deliverables are of paramount importance.

This position is only eligible for legal residents of the United States of America.

Key Responsibilities

Clinical Data Analysis:

• Identifying and investigating healthcare fraud, waste, abuse and other forms of billing activities leading to improper payments. This work involves reviewing medical professionals, facilities, insured members or the broker community in coordination with the customer’s carrier or third-party administrator
• Review claims data and conduct analysis to look for patterns of potential FWA and other improper payments
• Utilizing information from claims data analysis, plan members and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels
• Conduct data analysis to review claim and case history
• Reviews claims history, medical reviews, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends and financial relationships using state boards, licensing sites, Secretary of State sites, etc.

Collaboration and Stakeholder Engagement:

• Work closely with professional healthcare consultants, clinical teams and business analysts to understand the data needs of stake holders
• Collaborate with data scientists and engineers to build and refine analytics tools that enable improved decision-making
• Present findings and insights to internal teams, clients and stakeholders in a clear, understandable manner

Quality Control and Data Integrity:

• Ensure the quality, accuracy and integrity of clinical data by conducting data validation, cleaning and preparation
• Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets

Reporting and Documentation:

• Generate detailed reports, that communicate the analysis and its implications for clinical practices
• Document methodologies, assumptions and findings in alignment with industry best practices and regulatory requirement

Required Qualifications

• 3-5 years’ work experience related to healthcare fraud investigation, payment integrity operations and/or healthcare reimbursement
• Strong critical thinking skills
• Experience with computer research
• Experience with manipulating and analyzing large datasets
• Strong knowledge of clinical terminology, medical procedures and healthcare workflows
• Ability to be concise, independent and provide defensible decisions in writing
• Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
• Strong PC knowledge and skills, including all Microsoft Office products
• 3-5 years’ experience with CPT and HCPCS code terminology

Preferred Qualifications

• Highly desired – Prior experience investigating dental FWA and improper billing scenarios
• Professional certification as an Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE), or similar
• Certified Coding Specialist (AAPC or AHIMA)
• Undergraduate degree in or related to criminal justice or medical/clinical training
• Must have solid ability to accurately document findings in written form
• 3+ years of experience working in the group health business or experience in a health care provider’s practice
• Experience in the healthcare industry, clinical research or working clinical trials
• An intermediate level of knowledge with local, state & federal laws and regulations pertaining to health insurance (commercial health plans and/or dental plans)
• Experience with data analysis as it relates to healthcare claims adjudication

Skills and Competencies
Analytical Skills: Strong ability to interpret complex data and derive meaningful insights to drive healthcare outcomes

• Problem-Solving: Ability to identify issues in datasets and clinical workflows and suggest data-driven solutions
• Attention to Detail: High level of precision and accuracy in handling critical data
• Communication Skills: Excellent written and verbal communication, with the ability to present technical information to non-technical audiences
• Collaboration: Team-oriented with a focus on collaboration across multidisciplinary teams

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary:
We are seeking a highly skilled and experienced Senior Director of Account Management and Analytics Advisor to work with large, self-insured employers, focusing on the delivery of high-quality healthcare data analytics solutions. The ideal candidate will have a strong background in healthcare analytics and a proven ability to translate complex, data-driven insights into actionable strategies and clear, digestible content for both analytical and non-analytical stakeholders. This role will involve leading client relationships, managing internal resources toward timely deliverables and ensuring the effective utilization of analytics to drive value and client satisfaction.
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Key Responsibilities:
Account Management:

• Act as the primary point of contact for self-insured employer clients, ensuring satisfaction and fostering long-term relationships
• Serve as a trusted advisor, understanding client needs and challenges and offering strategic solutions to improve their healthcare programs
• Develop and maintain strong, strategic client relationships by understanding their business challenges and objectives, demonstrating exceptional problem-solving skills
• Coordinate and lead regular client check-ins, presentations and strategic reviews to ensure alignment and satisfaction
• Collaborate with internal teams (data, data science, clinical and investigative, executives etc.) to ensure optimal service delivery to clients
• Become fluent in healthcare claims data as relevant to company’s specific use case
• Nurture client relationships from infancy and throughout business relationship, including managing implementation process as needed
• Collaborate with new clients and their respective carrier(s)/data warehouse/PBM/other external constituents on all necessary documentation and other items in order to intake high-quality claims and health plan data

Data Analytics & Insights:

• Utilize advanced analytics tools and techniques to create insights that inform decision-making, cost-saving strategies and enhanced plan management
• Collaborate with internal teams to ensure the timely and successful delivery of data analytics solutions and insights
• Review client feedback and performance metrics to ensure solutions meet or exceed expectations
• Identify business enhancement opportunities that align with client needs and objectives
• Partner with the sales and solutions teams to develop strategic plans that address client goals
• Plan and lead client update presentations as well as ad hoc client meetings and written communications
• Assist the team in developing marketing initiatives, increasing business success and enhancing sales

Communication & Reporting:

• Translate complex data and analytical insights into clear, actionable reports and presentations for non-technical stakeholders
• Develop and deliver regular client-facing reports and presentations that highlight key performance metrics, trends, and opportunities
• Explain technical concepts in a simple, understandable manner for benefits leaders, client executives and other decision-makers with limited technical expertise

Project Management:

• Coordinate internal resources and timelines to ensure smooth implementation and delivery of projects
• Troubleshoot client issues in a timely and proactive manner, ensuring client satisfaction
• Monitor key performance indicators (KPIs) to track the success of initiatives and client satisfaction
• Delegating tasks effectively and managing team dynamics

Team Collaboration:

• Work closely with cross-functional teams such as data scientists, project managers and consultants to deliver cohesive client solutions
• Contribute to team-wide best practices, sharing insights and strategies to enhance client success
• Develop and maintain strong executive relationships

Qualifications:

• Education:

• Bachelor’s degree in business, marketing, economics, data analytics or a related field
• Master’s degree is preferred but not required

• Experience:

• 5–8 years of experience in account management, client success or related roles within data analytics, technology or consulting environments
• 4 years of experience in healthcare data analytics
• Proven experience managing senior-level client relationships and negotiating contracts or agreements

Skills and Competencies:

• Exceptional interpersonal and communication skills with the ability to understand and communicate technical insights to non-technical audiences in a tailored and thoughtful manner
• Ability to thrive in a fast-paced and lightly structured environment
• Hands-on, doer mindset
• Highly collaborative, team-focused, open communication and candid work style
• Strong problem-solving and strategic planning abilities
• Ability to break down complex problems into manageable components
• Identifying trends, patterns and key insights in data
• Developing actionable recommendations based on data analysis
• Understanding data analytics concepts, tools and methodologies, with the ability to translate insights into client strategy
• Proven ability to lead and manage projects independently
• Experience in managing deliverables within deadlines

Preferred Knowledge:

• Strong existing relationships within jumbo self-insured plan sponsor community
• Procurement/medical ASA and/or PBM contract negotiation experience
• Familiarity with benefit analytics, data warehousing and claims data files
• Exposure to statistical methods, data modeling or machine learning insights and how they inform business decisions
• Macro business knowledge of channels/industries relevant to the company’s client base (e.g. public sector, finance, healthcare, retail, technology, Taft-Hartley, etc.)

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste and abuse in healthcare through our proprietary data analysis. Our process works behind the scenes to save money while enhancing employee benefits and requiring no employee behavior changes.

APPLY HERE

Job Summary:

The perfect SQL Server Application Engineer applicant excels in T-SQL with hands-on experience writing queries, building stored procedures and creating custom functions. This role involves scrutinizing and debugging myDBR code, ETL data processing, data-driven decision-making, fostering collaboration with internal teams and keeping up to date with innovative technologies. Additionally, the engineer offers technical guidance and mentorship to ensure the triumph of software projects.

We are looking for an experienced SQL developer with a strong foundation in relational database report design, development and maintenance. The ideal candidate will demonstrate expertise in tools such as myDBR and MS SQL, alongside a commitment to industry best practices. Experience working with healthcare claims, HIPAA compliance and PHI data is highly desirable. This role encompasses managing the full software development lifecycle, including tasks such as design, modifications, data ingestion, processing, storage and analytics.

Additionally, as we evolve, the role will involve adapting our codebase for Azure cloud services to support future growth.

As part of this role, one will build relationships with other IT professionals, such as developers, data scientists and business analysts. Collaborate with these professionals to acquire a deep understanding of source systems, able to make decisions quickly and design and implement data solutions that meet the critical nature of the business.

This role is contract-to-hire. After a successful 3-month contract, you will be eligible for benefits and will transition to full-time employment.

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Key Responsibilities:

• Design and implement SQL databases to support business applications, prioritizing scalability, security, performance and reliability
• Develop and manage SQL stored procedures, views and scalar functions to ensure efficient and optimized database operations
• Architect and maintain complex relational database systems, ensuring integrity and performance across the platform
• Create and refine data models for applications, including metadata tables, views and related database structures to support application functionality
• Leverage myDBR to produce detailed reports, executive dashboards and ongoing operational analyses, providing actionable insights for process improvements and strategic decision-making
• Expertly identify, troubleshoot and resolve complex technical issues, ensuring minimal disruption to application performance
• Respond promptly to operational issues, implementing necessary fixes and optimizations to sustain peak performance and reliability

Job Summary:
The Senior SQL Full-Stack Developer excels in crafting top-tier software, taking charge of tasks throughout the software development life cycle. This role involves scrutinizing and debugging code, data processing, data-driven decision-making, fostering collaboration with internal teams and keeping up to date with innovative technologies. Additionally, the engineer offers technical guidance, mentorship and project management prowess to ensure the triumph of software projects.

We are seeking a highly skilled Senior Full Stack Azure Engineer to join our dynamic team. The ideal candidate will have extensive experience working with healthcare claims, HIPAA and PHI data. They should demonstrate expertise in Microsoft Azure cloud computing and MS SQL, along with a solid understanding of full-stack development principles. Proficiency in C#, RESTful API development and React are essential. In this role, you will play a pivotal part in designing, developing and maintaining scalable, secure and efficient cloud-based solutions that align with our organization’s goals and technological standards. Critical to have the ability to implement access controls, audit logging and encryption to protect sensitive information.

As part of this role, one will build relationships with other IT professionals, such as developers, data scientists and business analysts. Collaborate with these professionals to acquire a deep understanding of source systems, able to make decisions quickly and design and implement data solutions that meet the critical nature of the business.

This role is contract-to-hire. After a successful 3-month contract, you will be eligible for benefits and will transition to full-time employment.

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Key Responsibilities:

• Design, implement and manage highly scalable and secure Azure-based solutions
• Develop end-to-end web applications, including frontend and backend components, ensuring high performance and reliability
• Design and optimize complex MS SQL databases, including writing stored procedures, views, triggers, scalar functions and performance tuning 
• Leverage Infrastructure as Code (IaC) tools such as ARM templates, Bicep or Terraform to automate Azure resource deployment and configuration
• Collaborate with cross-functional teams to integrate cloud solutions with third-party applications and existing systems
• Implement CI/CD pipelines for automated testing, building and deployment using Azure DevOps or similar tools
• Develop and implement monitoring solutions and conduct proactive performance analysis to ensure system reliability and scalability
• Apply best practices for securing Azure environments, ensuring compliance with industry standards and regulations
• Leverage myDBR to generate comprehensive reports, support executive dashboards and perform ongoing operational analysis to inform management decisions and drive process and quality improvements
• Proficiently identify and resolve complex technical challenges
• Ensure prompt response to issues, implementing necessary corrections to maintain the optimal performance of the application