CLAIMS ANALYTICS ANALYST

As a Claims Analytics Analyst you will be responsible for accurately and efficiently reviewing contracts, researching healthcare provider claims and big data analytics including performing detailed quantitative analysis to draw conclusions and develop meaningful insights, thoroughly documenting your investigation results and identifying and implementing appropriate and effective resolution strategies.

Specific position responsibilities include:

  • Prioritize voluminous claim review workload.
  • Validate claim status, claim liability and availability of coverage.
  • Understand concepts of coverage, contract interpretation and reimbursement methodologies needed to analyze claims.
  • Demonstrate understanding of relationships between health plans and providers;
  • Have experience and appetite in analytics and quantitative/qualitative/data analysis, ideally in the healthcare sector
  • Research and analyze information including employing advanced health care analytics and data science techniques to diagnose reimbursement issues, opportunities assessment, claim trends, develop solutions and initiate appropriate claim resolution strategies.
  • Possess strong analytic and technical skills plus an ability to translate complicated data into useable information;
  • Maintain quality and productivity standards as set by Management.
  • Coordinates requests for analysis from internal and external clients including assignment, mentoring and establishing timelines.
  • Influence others using a positive approach.
  • Work independently with minimal supervision.
  • Perform special projects as requested.
  • Ensure compliance with Health Insurance Portability and Accountability Act.
  • Mentor junior staff.
  • Other duties as assigned.

Specific position qualifications include:

  • Five years or more of position specific related revenue cycle and big data analytics work experience (managed care, data mining and/or legal).
  • Superior critical thinking, analytical, problem solving and research skills.
  • Experience with Microsoft Office products; experience with healthcare provider claims management software highly preferred.
  • Excellent verbal and written communication skills.
  • Excellent knowledge of big data analytics, enterprise healthcare revenue cycle and billing operations and patient financial processes.
  • A special interest in exploring possibilities with machine learning a plus
  • Ability to multitask and thrive in a fast-paced work environment.
  • Strong organizational skills and highly detail oriented.
  • An interest in healthcare and healthcare law and the desire and ability to solve problems.

Qualified and interested applicants should send their cover letter including salary requirements and resume to cbennett@heltonlawgroup.com.