The Claims Business Analyst will directly impact change in the claims department and the overall organization by providing data, creating and maintaining departmental metrics and dashboards, creating reports to meet compliance requirements, and providing information and analysis that drive specific projects and strategic initiatives. The person in this position is instrumental in building accurate and timely analytic modeling and documenting processes. This person is responsible for analyzing a variety of health plan data. Key outputs include the aggregation of large datasets, creating accurate and timely analysis and reports, preparing timely and accurate reports related to regulatory filings, and working on cross functional data driven teams.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Responsible for analytic activities (data collection, modeling, analysis, reporting, & documentation), including, but not limited to, claims data, provider performance, departmental performance metrics and performance trends and contract negotiations.
- Analyzes data to generate dashboard metrics and reports at required intervals (e.g., monthly/quarterly) for the Claims staff and Claims leadership, senior management, and Board and Finance Committees.
- Analyzes data to generate reports as required for regulatory filings.
- Perform other related duties as required or assigned.
- Bachelors’ degree or equivalent in Business Administration, Information Technology, Health Care or related field required.
- Three years’ demonstrated experience in health care claims data analysis (contract analysis helpful) in a health plan setting preferred.
- Strong skills in Microsoft applications including MS Office; including advanced skills in MS Excel and MS Access; Experience using SQL to query databases; Experience with data analytics software such as Tableau or similar tools.
- Must have a proven track record of working and leading cross functional teams.
- Must be able to explain health care claims data and its relation to third party provider contractual arrangements.
- Must be able to compile and present health care claims data in a meaningful and useful manner to inform leadership for the purpose of data-driven decision-making. This includes transforming data into trending graphs and charts.
- Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies, particularly senior management; ability to develop and deliver presentations.
- Excellent time management, organizing and coordinating skills.
- Strong history of achieving personal and corporate goals and objectives.
- Must demonstrate professionalism, good judgment, and tact when dealing with sensitive and confidential issues.
- Familiar with Medicare and Covered CA regulations.
In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.