- Education and Experience: Bachelor’s degree in Economics, Finance, Statistics, Actuarial, or a health-related field of study.
- Minimum five (5) years of financial and data analysis experience, with a focus in healthcare data analysis highly preferred.
- Knowledge of: Principles and practices of financial management. Complex data analyses. Methods of report preparation, writing and presentation.
- Statistical research, analysis and techniques.
- Healthcare industry data reporting standards, terminology, and guidelines.
- Medical and Medicare claims billing policies and procedure codes.
- Personal computers with a proficiency in database management and Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
- Collect, analyze, summarize and interpret health care data, including claims, capitation, member, and provider information.
- Develop and prepare decision support tools to advise client on activities related to medical cost trends, utilization of medical services, and provider reimbursement.
- Complete analysis of high cost drivers of medical costs and identify the underlying unit cost and utilization trends.
- Prepare monthly and quarterly reports and executive dashboards on medical cost performance and trends.
- Calculate monthly reserves required for IBNR and present monthly IBNR analysis and recommendations to management.
- Complete required governmental reporting, including State health care cost reconciliations and CMS annual MLR filings.
- Conduct special analyses and projects at the direction of management for all lines of business as necessary.
- Perform other duties as assigned.
- Work with relational database concepts and applications.
- Analyze and evaluate a variety of complex financial issues and recommend effective solutions.
- Apply critical thinking and problem solving skills to complex analyses.
- Prepare clear and concise reports.
- Communicate analysis clearly and concisely in writing and verbally.
- Interact and work effectively with other departments and management.
- Achieve high degree of accuracy on all reports and analysis and possess excellent attention to detail.
- Work with minimal supervision while managing multiple tasks and meeting established deadlines.