Analyst, Payment Integrity
Pune, Maharashtra, India


Job title

Analyst, Payment Integrity


Claims Discovery

Report To

Phillip Evans

No of yrs. of exp


Work Location


No of Positions


Assigned Recruiter


Talent Partner



Version Control

Version No.



Updated by




Kevin O’Donnell


It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

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Position summary

As a critical team member of the Payment Integrity team partnering with Health Plan Services (HPS) this role helps to support the analytics and reporting for Payment Integrity Services. The Analyst for Payment Integrity is responsible to support the needs and direction of the Claims Discovery Leader and priority initiatives for payment integrity related to existing HPS clients. Given the nature of the role, (s)he is expected to employ a consultative and analytical approach to issue resolution.

This role is an ideal fit for someone who enjoys working in a fast-paced, hands-on, client-facing environment with a heavy focus on cross functional operations and process improvement. This individual also helps track performance against SLA’s and other key performance indicators.

This is role is meant to be a foundational starting point to develop and launch outstanding talent and future leadership into the HPS organization. Reporting to the Associate Director, Payment Integrity and has multiple career path options to grow into.     
Essential functions


  • Support the Payment Integrity Team reporting needs, e.g.:
    • Retraction files (promoting uniformity for data load)
    • Monthly membership file
  • Assist with developing and maintaining:
    • Financial reports
    • Executive status reports
    • Standard stack of Payment Integrity related reports
  • Build Payment Integrity data warehouse tables that support multiple clients and functions
  • Generate ad hoc data analysis as needed
  • Develop and standardize the identification of in-house audit Concepts
  • Build user guides for newly created analytic processes
  • Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues
  • Participate in documenting and prioritizing potential solutions to issues & fallout for system issues
  • Establish and implement interim workaround solutions as needed and communicate to all impacted users
  • Effectively handle multiple initiatives as the same time
  • Other duties as assigned

Academic Qualification

  • Associate or Bachelor degree preferred.
  • Experience in health insurance claims processing
  • HMO Claims or managed care environment preferred.

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