Risk Compliance Analyst Visa Sponsorship Jobs in Kentucky
Kentucky's risk compliance analyst roles are concentrated in Louisville's financial services and healthcare sectors, with employers like Humana, Anthem, and Stock Yards Bank regularly hiring for compliance functions. Lexington and the greater Cincinnati border region add additional opportunities across banking, insurance, and manufacturing compliance teams seeking experienced analysts.
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Get Access To All JobsJOB DESCRIPTION
Job Summary
Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.
Essential Job Duties
- Business Leadership & Operational Ownership
- Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
- Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
- Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
-
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.
-
Analyze data to identify and develop new recovery opportunities
- Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
- Responsible for documenting policies and procedures related to concept approvals
- Conduct trainings and prepare training documentation for teams
- Other duties as assigned
Strategic Business Analysis
- Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
- Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
- Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
- Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.
Applied Analytical Support
- Uses data analysis tools/systems to support business analysis.
- Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
- Creates succinct summaries and visualizations that enable faster leadership decision-making.
Required Qualifications
- At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
- Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
- Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
- Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
- Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
- Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
- Strong written and verbal communication skills, including ability to synthesize complex information.
-
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.
-
Claims processing background
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Preferred Qualifications
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
- Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
- Project management experience.
- Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
JOB DESCRIPTION
Job Summary
Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.
Essential Job Duties
- Business Leadership & Operational Ownership
- Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
- Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
- Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
-
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.
-
Analyze data to identify and develop new recovery opportunities
- Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
- Responsible for documenting policies and procedures related to concept approvals
- Conduct trainings and prepare training documentation for teams
- Other duties as assigned
Strategic Business Analysis
- Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
- Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
- Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
- Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.
Applied Analytical Support
- Uses data analysis tools/systems to support business analysis.
- Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
- Creates succinct summaries and visualizations that enable faster leadership decision-making.
Required Qualifications
- At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
- Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
- Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
- Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
- Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
- Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
- Strong written and verbal communication skills, including ability to synthesize complex information.
-
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.
-
Claims processing background
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Preferred Qualifications
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
- Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
- Project management experience.
- Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Risk Compliance Analyst Job Roles in Kentucky
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Search Risk Compliance Analyst Jobs in KentuckyRisk Compliance Analyst Jobs in Kentucky: Frequently Asked Questions
Which companies in Kentucky sponsor visas for risk compliance analysts?
Louisville-based employers in financial services and healthcare are the most active sponsors for risk compliance analyst roles in Kentucky. Humana, Anthem, and regional banks such as Stock Yards Financial and Republic Bancorp have histories of H-1B visa sponsorship for compliance and risk functions. Larger national firms with Kentucky operations, including insurance and logistics companies, also sponsor candidates for these roles when qualified domestic applicants are scarce.
Which visa types are most common for risk compliance analyst roles in Kentucky?
The H-1B is the most common visa for risk compliance analysts in Kentucky, as these roles typically require a bachelor's degree in finance, accounting, business, or a related field, satisfying the specialty occupation requirement. Candidates with advanced degrees may also see employers pursue an H-1B with a master's cap exemption. TN visas are an option for Canadian and Mexican nationals whose credentials and job duties align with the applicable USMCA professional categories.
Which cities in Kentucky have the most risk compliance analyst sponsorship jobs?
Louisville accounts for the majority of risk compliance analyst sponsorship activity in Kentucky, driven by its concentration of financial institutions, insurance carriers, and large healthcare employers. Lexington is the second-largest market, with opportunities across banking and healthcare compliance. The northern Kentucky corridor near Cincinnati also generates demand, as multistate employers based across the Ohio River frequently fill compliance roles from both sides of the border.
How to find risk compliance analyst visa sponsorship jobs in Kentucky?
Migrate Mate filters job listings specifically by visa sponsorship availability, making it straightforward to identify risk compliance analyst openings in Kentucky where employers are actively willing to sponsor. You can search by role and state to surface positions at financial services, healthcare, and insurance employers across Louisville, Lexington, and the northern Kentucky region, saving time you would otherwise spend screening listings that do not offer sponsorship.
Are there any state-specific considerations for risk compliance analysts seeking sponsorship in Kentucky?
Kentucky's compliance hiring is heavily shaped by its regulated industries: insurance, banking, and healthcare each carry distinct licensing and regulatory requirements under state law, which employers factor into hiring decisions. Candidates pursuing sponsorship should be prepared to demonstrate familiarity with relevant federal frameworks such as BSA, AML, or HIPAA depending on the sector. Kentucky does not have its own state-level immigration program, so federal visa categories govern all sponsorship pathways.
What is the prevailing wage for sponsored risk compliance analyst jobs in Kentucky?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.