Claims Analytics Consultant

Job Description/Skills:
This is a fully remote position.

ABOUT THE JOB
The Claims Analytics Consultant will focus on helping the business understand, monitor, and leverage medical and Rx healthcare claims.  The candidate will do this with strong analytic approaches in gathering claims data to solve problems, helping to support the development of the optimal claims ingestion process, providing quality assurance techniques, and monitoring claims for accuracy and completeness.
The claims analytics consultant will be accountable for ensuring claims are accurate and quality assurance processes are put in place and followed.  They will be responsible for assisting in developing optimal quality assurance processes, and the first point of contact for all departments with management of claims data issues.  They will leverage their analytics, technical, and healthcare claims experience to create and maintain a comprehensive process for leveraging claims information effectively.
ESSENTIAL DUTIES & RESPONSIBILITIES

• Collaborate with business stakeholders to understand claims analytics and reporting needs regarding ingestion and use of claims.
• Develops reporting to enhance our ability to understand and act upon claims-based information including costs, clinical trends, disease pattern, usage patterns by service type, and other key claims results.
• Knowledge and experience working with both medical and Pharmaceutical claims databases.
• Acts as the SME in development of a claims database, claims understanding of coding and usage, claims costs and claims analytics.
• Helps support the organization in effectively leveraging claims in helping transform lives.
• Has solid understanding of the claims processing system in the health plan arena and comprehensive understanding of claims based financial, utilization, and clinical metrics.
• Assists teams in creating claims processes that ensure accuracy of claims data, accuracy of the quality review process, a deeper understanding of the QA process for monitoring large claims data sets.
• Produce clear and concise summaries of claims insights and analytical findings for easy consumption by a variety of audiences throughout our client and their external clients.
• Responsible for internal reporting as well as ad-hoc data queries and proactive analysis to help support comprehensive understanding of our claims data and warehouses.
• Gathers, manages, and synthesize large amounts of information effectively and creatively.
• Analyze external/internal claims and clinical data and provides recommendations on improving our claims analytics.
• Ensures reports and presentations are visually appealing.
• Document process flows and create standard operation procedures for reporting.
• Ensures consistency in reporting products.
• Other Duties as Assigned

QUALIFICATIONS
Bachelor’s degree in a directly related field and 5-7 years of professional experience working with Health Plan claims.  SQL/SAS coding skills are required. Strong understanding of healthcare data and possess the ability to communicate complex information to multiple levels of internal/external individuals.  Preferred familiarity with Medical coding.

• Understanding of EDW/Datawarehouse Environment
• Tableau/Data Visualization
• MS Office Skills including PowerPoint, Excel, Word

DESIRED ATTRIBUTES

• Understanding Large Data Sets
• Must have health plan claims experience
• Communication to multiple levels of an internal/external organization
• Ability to present complex information effectively.
• Strong data visualization techniques
• Ability to handle multiple high priority requests effectively

Pay Range: $55.00 – $65.00 per hour, depending upon experience.
Health & Medical Benefits, 401K, Employee Assistance Program, and Sick Time applicable by state.