The Senior Healthcare Claims Data Analyst will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently.

Candidate should have experience and knowledge across a breadth of health care claim domains. This includes Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas. Previous claim payment experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with provider billing practices, claim system limitations, and provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.

*Salary Range for this role is: $93,900 - $154,200

For more information on benefits and what we offer please visit us athttps://www.exlservice.com/us-careers-and-benefits

• Pull and integrate data from disparate sources (e.g. claims, membership/enrollment, etc.)
• Perform quality assurance reviews on data and document the findings
• Interpret, analyze and present key findings to internal team & business partners
• Conduct deal reviews and work with appropriate stakeholders
• Publish the attribution status to all required stakeholders
• Research on issues related to attribution and co-ordinate with required stakeholders to bring it to closure
• Provide user guide and maintain documentation on existing attribution methodology
• Help develop the tools for quality and transparency for attribution
• Become the analytical, technical and business co-lead
• Coding responsibilities will include HIVE, SQL, and Python primarily.

Must have:

• Minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience
• 5-7 years of relevant hands-on data analysis experience
• 5-7 years of relevant medical claim experience across Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas
• Strong Healthcare Insurance data experience
• Experience in using business tools to query large datasets, e.g., SQL, SAS Enterprise Guide, Claris, Pareo, Optum.
• Demonstrates good written and verbal communication skills.
• Able to present information to various audiences 6 Technical and Non-Technical

Good to have:

• Ability to work with large data sets from multiple data sources.
• Excellent communication skills with strong background working directly with coworkers and clientele to identify business objectives and establish requirements
• Worked in a team environment and also coordinated with business/functional team
• Experience working with Azure Databricks
• Experience with development and/or knowledge of Claims Code Edits
• Knowledge and experience across multiple Claims Systems such as QNXT, Facets, and TOPS