Healthcare Claims Data Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess trends in the utilization of healthcare products and services by analyzing historical data.

• Extract, organize, and interpret medical health claims data to uncover root causes.

• Gather and merge data from various sources, including claims and membership/enrollment information.

• Conduct quality assurance reviews on data and document any findings.

• Analyze, interpret, and present significant findings to internal teams and business partners.

• Facilitate deal reviews and collaborate with relevant stakeholders.

• Distribute attribution status updates to necessary stakeholders.

• Investigate attribution-related issues and work with stakeholders to resolve them.

• Create user guides and maintain documentation regarding attribution methodology.

• Assist in the development of tools for attribution quality and transparency.

• Act as a co-lead in analytical, technical, and business capacities.

• Primarily code in HIVE, SQL, and Python.

⛳️ Requirements

• Bachelor's degree or equivalent experience is required.

• 5-7 years of practical data analysis experience is preferred.

• 5-7 years of relevant medical claim experience in areas such as Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM.

• Strong experience with Healthcare Insurance data is essential.

• Proficient in using business tools to query large datasets, such as SQL, SAS Enterprise Guide, Claris, Pareo, and Optum.

• Excellent written and verbal communication skills are necessary.

• Ability to present information effectively to both technical and non-technical audiences.

• Capability to work with large datasets from various data sources.

• Familiarity with Azure Databricks is advantageous.

• Experience with development and/or knowledge of Claims Code Edits is beneficial.

• Knowledge and experience with claims systems like QNXT, Facets, and TOPS are required.

🏝️ Benefits

• A dynamic, fast-paced, and innovative work environment.

• Opportunity to collaborate closely with seasoned, world-class analytics consultants.

• Opportunities to gain insights into various aspects of clients’ businesses.

• Training in analytics and advanced analytical tools and techniques.

• Mentoring program providing guidance and support from senior professionals.

• Opportunities for growth and professional development.

• Flexible remote work options.