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The incumbent will collaborate closely with the Operational Analytics team, as well as other colleagues, across product, operations, medical management, and provider contracting to support and implement high-quality, data-driven decisions. The ideal candidate has a knack for seeing solutions in data sets and the business mindset to convert insights into strategic opportunities. They will ensure data accuracy and consistent reporting by designing and creating optimal processes and procedures for analytics employees to follow. They will use advanced data modeling, predictive modeling, and analytical techniques to interpret key findings from company data and leverage these insights that will help us design, build, and manage our health plan.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master’s Degree with Internship in Business Administration, Mathematics, Computer Science, Statistics, Information Systems, or a related field.
EXPERIENCE:
1. Two (2) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk.
OR
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor’s Degree in Business Administration, Mathematics, Computer Science, Statistics, Information Systems, or a related field.
EXPERIENCE:
1. Two (2) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company.
2. Two (2) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Two (2) years of experience working with Medicare and/or Medicaid Data.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Leverages complex analytical tools to provide business and technical expertise to create data driven solutions.
2. Partners with product, operations, medical management, and provider contracting teams to understand & anticipate reporting requirements, priorities, and key performance indicators.
3. Supports key business stakeholders, translating data into actionable insights using appropriate analytical solutions.
4. Produces repeatable and ad-hoc reports for key business stakeholders to measure and interpret business trends.
5. Participates in a variety of assigned operations initiatives to ensure success in meeting business goals and objectives.
6. Collects report requirements – interviews and researches business stakeholder needs; drafts, edits and validates requirement documentation.
7. Provides input on project plans, scope of work, status, and project summary reports.
8. Communicates results of analysis effectively and regularly to business stakeholders.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Working at a computer.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Work will primarily be completed in a remote setting. Occasional travel to office may be required.
SKILLS AND ABILITIES:
1. Strong programming skills with query languages such as SQL and the ability to perform effective querying from multiple tables and databases.
2. Experience with querying tools such as Microsoft SQL Server Management Studio.
3. Experience with data visualization tools such as Tableau.
4. Experience working with Oracle, Teradata, Hadoop, etc.
5. Strong problem solving and quantitative abilities.
6. Excellent communication and collaboration skills.
7. Attention to detail.
8. Effective time management and organizational skills.
9. Work independently as well as in a team environment.
10. Proficient computer skills, including experience with Microsoft Office Suite such as Excel functionality (pivot tables, vlookups, macros, etc.)
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
PHH Peak Health Holdings
Cost Center:
2903 PHH Operational and Provider Analytics