Data Analyst - Claims

As a Data Analyst - Claims with expertise in medical claims, you will be responsible for analyzing, interpreting, and presenting data related to medical claims to support decision-making and operational efficiency. You will work closely with cross-functional teams to identify trends, generate reports, and develop strategies to enhance claims management and processing.

Key Responsibilities:

Data Analysis & Reporting:

• Analyze large datasets related to medical claims, including billing codes, patient demographics, and claim status.
• Develop and maintain reports and dashboards that provide insights into claims trends, processing times, and reimbursement rates.
• Identify and address discrepancies in data, ensuring accuracy and completeness.

Claims Management:

• Evaluate and interpret medical claims data to identify patterns, anomalies, and areas for improvement.
• Collaborate with claims processors and medical coders to resolve issues and optimize claims processes.
• Monitor and assess the impact of changes in regulations, policies, and procedures on claims processing.

Data Visualization:

• Create visualizations to communicate findings effectively to stakeholders, including charts, graphs, and dashboards.
• Present data-driven recommendations to management and other departments.

Cross-Functional Collaboration:

• Work with IT and software development teams to ensure the integration of claims data into analytical tools and systems.
• Assist in the development and implementation of data-related policies and procedures.

Compliance & Quality Assurance:

• Ensure that data handling and analysis comply with relevant regulations and standards, including HIPAA and other data protection laws.
• Conduct regular quality checks to maintain data integrity and accuracy.

Qualifications:

• Education: Bachelor’s degree in Data Science, Statistics, Computer Science, Health Informatics, or a related field. Advanced degree or relevant certifications (e.g., Certified Health Data Analyst (CHDA)) preferred.

Experience:

• Proven experience as a Data Analyst, preferably with a focus on medical claims or healthcare data.
• Strong understanding of medical billing codes (e.g., ICD, CPT, HCPCS) and claims processing workflows.
• Experience with data analysis tools and software (e.g., SQL, Excel, Tableau, Power BI).

Skills:

• Proficient in data analysis, statistical methods, and data visualization techniques.
• Excellent problem-solving skills and attention to detail.
• Strong communication skills, with the ability to present complex data in a clear and actionable manner.
• Ability to work independently and as part of a team in a fast-paced environment.

Preferred Attributes:

• Knowledge of healthcare regulations and compliance standards.
• Familiarity with Electronic Health Record (EHR) systems and their data structures.
• Experience with data integration and ETL processes.

Pay Range: $100,000 - $120,000 annually.