designs and executes claim operational analysis, creating insight into the Medical and Dental claim operational environments
evaluates the operational and financial flow of claims throughout the claim lifecycle, across multiple claim systems
builds information resources to support tactical operational needs
fulfills requests for operational data
performs a variety of analysis to support Service Operations' needs
provides valuable information to decision-makers

Requirements

3+ years’ experience using SAS, BigQuery, SQL, Python, or similar query language, to extract, transform, process, and summarize large datasets
2+ years performing large scale analysis on medical claim operational (i.e., non-clinical) data. Examples such as auto-adjudication rates, turnaround times, payment patterns, inventory composition, denial rates, etc.
Demonstrated business knowledge of the medical claim lifecycle (Claim Intake, Adjudication, Editing, Pend/Inventory management, Payment, Appeals, Rework)
Demonstrated ability to manage multiple projects simultaneously
Experience performing data 'quality and reasonableness' testing on claim operational data
Strong Excel skills, including mastery of logical & text functions, pivot tables
Experience applying logic and critical thinking to solve business problems involving operational data
Experience turning data into information
Excellent written communication skills.

Benefits

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SASBigQuerySQLPythondata analysisdata transformationdata processingdata summarizationExceldata quality testing

Soft Skills

critical thinkingproblem solvingproject managementcommunication