JOB DESCRIPTION Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES Provides healthcare analysis including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory mandates, and claims data coordination. Manages small to large scale projects initiated by both health plan and Corporate Parent. Designs and develops solutions to support business needs using various technologies. Analyzes all in bound requests and determines appropriate technology solution for an effective and efficient delivery. Quality oversight mechanisms to include reconciliation guidelines, mentoring guidance and new employee training. Provides Administrator level support for share point and reporting services. Accomplishes the goals and objectives of the Finance, Research and Analytics team. Responsible for prioritization and timely completion of all tasks and report requests as assigned thru the share point request system.
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Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees