Senior Manager - Data Analyst for Medical Health Claims

EXL•United States,

About The Position

The Senior 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 in health care claims. This includes Inpatient, Outpatient, SNF, Rehab, Professional, DME, HCD/HIT 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, provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.

Requirements

Experience and knowledge in health care claims (Inpatient, Outpatient, SNF, Rehab, Professional, DME, HCD/HIT areas)
Understanding of Medical claim terminology and insurance terminology
Ability to work independently
Proactive thinker
Self-starter
Ability to work in a fast-paced and challenging environment

Nice To Haves

Previous claim payment experience
Experience with provider billing practices
Experience with claim system limitations
Experience with 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
Develop cost effective quality product / services
Retrieve, organize and perform research/analysis on Medical Health Claim data primarily to identify root cause