Business Analytics Advisor-Payment Integrity Team (Hybrid)

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Role Description:

This role will support Payment Integrity projects through analysis of medical expense to determine total medical cost (TMC) savings for both proposed and implemented initiatives and performance of existing programs.

Conduct moderate to complex data analysis projects and/or reporting as well as understanding and presenting results and opportunities to key matrix partners at various levels of the organization.

This individual will partner with network and Clinical Operations, Payment Policy Unit, and other matrix partners to understand how proposed initiatives will work, how the actual savings will be tracked, and analyze the current medical expense to estimate annual savings from the proposed changes.

This role also will assist in building tools and reports to track medical cost expense and highlight emerging trends and outliers.

Responsibilities:


* Position will act as a key subject matter expert for the Payment Integrity team in regards to medical expense analysis and current program maintenance


* Works closely with teams of internal SMEs, project managers, medical directors and others involved in the evaluation to develop rules and assumptions and to provide an accurate assessment of the potential savings for policy changes and total medical cost initiatives.


* Design and maintain dashboards and reports using Tableau or other data visualization tools.


* Monitor program performance using KPIs and dashboards, monitor operational performance of initiatives and adjust strategies based on evolving business needs or regulatory changes.


* Analyze large-scale healthcare datasets (e.g., claims, utilization, provider performance) to identify trends, cost drivers, and opportunities for intervention


* Regularly monitors results, efficiently addresses variance and implements corrective action


* Support medical cost trend reduction by transforming data into actionable reports and dashboards which provide insight into TMC savings opportunity


* Track performance of TMC initiatives and policy changes post implementation.


* Use SAS, SQL or other related applications to query claims data and convert data into meaningful information.


* Support identification of affordability initiatives through analysis of outlier trends and review of competitive policy.


* Understand and present medical cost results to key matrix partners at various levels of the organization.

Qualifications:


* Bachelor's degree in Statistics, Mathematics, Economics, Health Policy Analysis, Finance or equivalent.


* 5+ years of experience with health care analytics required.

Experience ...