Healthcare Claims Data Analyst
About The Position
The Senior Healthcare Claims Data Analyst will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently. Candidate should have experience and knowledge across a breadth of health care claim domains. This includes Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas. Previous claim payment experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with provider billing practices, claim system limitations, and provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.
Requirements
- Experience and knowledge across a breadth of health care claim domains including Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas.
- Understanding of Medical claim terminology and insurance terminology.
- Proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently.
Nice To Haves
- Previous claim payment experience.
- Experience with provider billing practices, claim system limitations, and provider contracting terms.
- Experience in Pre Pay and Post Pay.
Responsibilities
- Support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services.
- Retrieve, organize and perform research/analysis on Medical Health Claim data primarily to identify root cause.
Benefits
- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
