Collaborate with claims and stop loss operations teams to understand analytics and reporting needs that drive efficiency and scalability.
Scope, gather, and structure requirements into actionable opportunities and solutions.
Extract, manipulate, and analyze large datasets from claims databases using SQL or similar querying languages.
Translate data into actionable insights and strategic recommendations that inform process improvements, resourcing decisions, and operational priorities.
Develop models and algorithms to identify trends, anomalies, root causes of inefficiencies and areas for operational improvement.
Design and maintain scalable dashboards and reports using tools like Tableau, Power BI, or similar platforms.
Create and monitor productivity and performance metrics to assess and enhance departmental efficiency.
Present findings to operations leadership with clear narratives that tie analytics to business outcomes.
Serve as a technical liaison between claims operations and the core data team to ensure accuracy and quality in analytics.
Develop and maintain SLA reporting to ensure claims operations meet and exceed client expectations.
Proactively identify and recommend areas for automation, workflow enhancements, and optimization across the claims lifecycle.
Ensure data integrity and accuracy across all analyses.
Requirements
Bachelor’s degree in Data Science, Statistics, Healthcare Administration, or a related field.
5 years of experience in data analytics, preferably within healthcare or insurance claims operations.
5 years of experience in healthcare, claims processing, stop loss reporting and data needs and relevant regulations (e.g., ACA, HIPAA).
Proficiency in SQL with the ability to write complex queries and manipulate large datasets.
Strong skills in Python or R for data analysis and insight generation.
Strong skills in building interactive dashboards using Tableau, Power BI, or equivalent tools.
Familiarity with data warehousing and cloud platforms (e.g., AWS, Snowflake).
Benefits
Offers Equity
Offers Bonus
Applicant Tracking System Keywords
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