- Accounts Receivable support – Provide data analytic support and automation on reconciliation of eligibility files, capitation payments, repricing payments, etc.
- Accounts Payable support – Enhance reporting of Medical Loss Ratio and Profit/Loss trends through the ingestion of multiple data sources, ensuring data is clean and normalized for accurate reporting.
- Utilization Management support – Build data models for appropriate monitoring of outliers; billing integrity; Fraud, Waste, and Abuse (FWA); Special Investigation Unit (SIU)
- Business Development support – Build models to enable proper pricing for proposals on a capitated or fee for service bases, analyzes potential client claims data, provider network adequacy, provider contract fee schedule and applies logic to pricing models for necessary adjustments.
- Meet with leadership to gather information regarding the goal of a project and define requirements for reporting and monitoring at a level appropriate for the audience.
- Collaborate with Operations leadership to develop departmental reporting for monitoring user productivity using complex backend activity logs.
- Interact with internal clients to evaluate products and performance using both internal and external data sources.
- Always maintain objectivity to ensure reporting, processes and products are relevant.
- Make data-driven decisions and recommendations.
- Articulately and concisely explain the implications of complex data including identification of inaccurate replication, misrepresentation of data, bad joins, production structure and input errors.
- Performs other related duties as assigned by management.
- Minimum of 5 years' experience working in analytics or relevant position in the Healthcare, Medical Insurance or Transportation industry
- Solid computer skills, including The Microsoft Office Suite, most specifically MS Excel, MS Access, and web-based applications.
- AWS/Redshift is desirable
- Significant work experience in SQL Coding
- Significant experience with Data visualization tools like Power BI, or Quicksight
- Keen eye for details and aptitude for working with data and data validation
- Highly accurate and thorough in all tasks
- Exceptional organizational, prioritization of tasks, and presentation skills
- Outstanding written, verbal, and interpersonal skills
- Strong problem-solving skills and an analytical mind
- Proven experience as a collaborative team player
- Able to thrive in a fast-paced, deadline-driven environment
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Sr. Business Analyst - Doral, United States - Alivi
Description
JOB SUMMARY:
The business intelligence analyst will conduct thorough data analysis, design, and implement analytic programs, generate reports, and collaborate with various teams to ensure we have the data necessary to optimize our resources, product performance and maximizing our market share.
Creates reports, visualizations, dashboards, and metrics that provide business insight and aid business decision-making.
Uses querying languages like SQL, scripting languages like R or Python, and other tools like Tableau, QuickSight or Excel to produce reports and perform meaningful quantitative or qualitative analyses addressing impactful business issues or questions.
Combines these reports with subject-matter expertise to deliver coherent, insightful takeaways and advice. Collaborates with project stakeholders to better understand valuable objectives and KPIs and to design relevant reports and dashboards. Bachelor's degree preferred. Typically reports to a supervisor or manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function.DUTIES & RESPONSIBILITIES
