Employer: WelbeHealth
The Claims Data Specialist will be responsible for compiling and analyzing healthcare claims, authorizations, and provider data and performing related duties to include tracking trends, identifying patterns, and/or detecting irregularities and will report on critical KPIs and data in order to drive quality outcomes. The emphasis of this role will be placed on the ability to work independently, meet deadlines, and understand complex healthcare claims data. The ideal candidate will have exceptionally strong analytical abilities with a track record for identifying insights from quantitative and qualitative data. The Claims Data Specialist collaborates effectively with colleagues and stakeholders to promote the WelbeHealth values, team culture and mission.
Duties and Responsibilities:
- Proactively develop actionable plans for identifying and reporting patterns related to claim denials, payouts of interest, overturned appeals, quality, usage, cost, and other variables.
- Cleanse, merge, and analyze HPS claims, authorization, and provider data required to generate dashboards and reports for quality, operational, and financial purposes.
- Build complex quantitative and qualitative analysis, documenting current and future state business processes, manage project logistics, and monitor the success of project goals.
- Analyze existing and proposed workflows to ensure they support efficient business practices and align with key performance indicators.
- Maintain currency in existing and emerging analytic techniques, tools, patterns and practices.
- Establish, document, and manage stakeholder expectations regarding delivery scope and timeline.
- Other duties as assigned.
Qualifications and Requirements:
- Bachelor’s Degree in relevant field; may substitute four years’ experience in lieu of education.
- Minimum of four years’ experience with SQL, SAS, Tableau, Power BI or other analytical and business intelligence tools.
- Minimum of three years’ experience processing, researching and analyzing healthcare claims preferred.
- Proficient in Excel.
- Experience in an analytics role at a health plan, consulting firm, hospital system or other healthcare related experience required.
- Working knowledge of the health plan insurance industry, CPT/HCPCS procedure codes, and relevant federal and state regulations.
- Experience working with CMS and Medi-Cal healthcare claims strongly preferred.
- Strong organizational, analytical, communication, and time management skills
- Excellent critical thinking and decision-making skills.
- High attention to detail.
- Ability to work independently with minimal supervision.
- Demonstrated ability to prioritize in a fast-paced environment.
- Experience and competency working with people from diverse backgrounds and cultures.
- Commitment to unlocking the full potential of our most vulnerable seniors.
- Bilingual English/Spanish preferred.