Utilize reference data sources and advanced validation techniques to ensure accuracy, completeness, and integrity of healthcare claims data
Assess provider scoring methodologies, identify discrepancies, and develop insights to optimize coverage accuracy
Design, develop, and maintain retrospective models for historical performance analysis and predictive models to identify high-risk patients
Translate complex analytical findings into clear, actionable insights for internal stakeholders and external clients
Aggregate and reconcile multiple data sources, applying statistical and computational methods to verify data integrity and identify anomalies
Execute comprehensive data analysis workflows, evaluate outcomes, and implement enhancements to improve model accuracy and data reliability
Review and optimize claim-matching processes, troubleshoot inconsistencies, and resolve data discrepancies
Investigate data quality issues, conduct root cause analysis, document findings, and deliver recommendations for process improvements
Collaborate with cross-functional teams to enhance analytical tools, refine methodologies, and implement scalable solutions
Maintain adherence to security protocols (VPN, secure passwords, company-approved devices/software) and HIPAA compliance
Requirements
Bachelor’s degree in a quantitative field (e.g., Statistics, Mathematics, Engineering, Computer Science, Finance, or Economics) or equivalent professional experience
Five (5) or more years of experience analyzing healthcare claims data
Proficiency in SQL for querying and manipulating data
Familiarity with Python or similar data tools preferred
Advanced Excel skills, including PivotTables and complex formulas
Knowledge of healthcare network rosters, provider data, and quality measurement methodologies
Strong analytical, problem-solving, and critical-thinking skills
Exceptional attention to detail and commitment to accuracy, data validation, and quality assurance
Highly organized and self-motivated, with ability to manage multiple priorities independently
Ability to translate complex analytical findings into clear recommendations
US-based work location required and ability to comply with company policies such as HIPAA
Reliable internet connection and a quiet, distraction-free workspace