Medical Data Claims Analyst II
Posted on Aug 11, 2019 by AmTrust Financial Services
AmTrust North America Claims is looking for an experienced Claims Analyst II to build an operational reporting suite as well as deliver on several high impact and high visibility analytical projects.
AmTrust, a Fortune 500 company has seen significant growth since inception fueled by numerous acquisitions over the years. While the companys revenue has grown, the number of claims as well as complexity of claims has grown with it. This has created an opportunity for us to better leverage our scale and vast amounts of data to identify opportunities to operate more efficiently.
This position will report to the Director of Claims Operational Analytics and will Matrix to the Head of Managed Care and Clinical. This role will support the Managed Care and Clinical Organization by providing data, analytics and reporting to identify opportunities to improve efficiency and effectiveness in the Claims organization. The right candidate will bring a balance of Claims technical expertise, medical data expertise, analytical abilities, creativity and execution to the table.Responsibilities
- Identify, synthesize and recommend actionable analytical insights to drive improved claims outcomes
- Perform detailed analyses using large volumes of claim data including both medical and prescription drug claims information including data scrubbing/cleaning, aggregation, subsetting, and clustering
- Derive actionable insights from healthcare data (claims, medical, pharmacy, lab, survey, utilization review, and externally sourced) to engage and enable claim strategy and evaluate programs and product solutions
- Partner with corporate analytics to build predictive models and AI solutions to develop a little to no touch claims handling environment
- Maintain thorough understanding of healthcare and hospital terminology and industry trends and ideas for data analysis
- Support Managed Care leadership team with ad-hoc analytical requests
- Support the build out of executive level presentations with actionable insights and recommendations
- Establish a monthly claims operational reporting package that includes dashboard, scorecards, and reports
- Collaborate with IT on data cube development and SQL Server enhancements and reports utilizing Power BI, MS Excel and SQL
- Bachelors Degree from a top university
- 3+ years of Property and Casualty industry experience
- 3+ years experience supporting workers compensation and managed care with a focus on claims data, analysis, and data discovery, especially with respect to cost, utilization, and outcomes
- 1+ years of experience working with Business Intelligence tools such as Power BI, Cognos or Business Objects
- Ability to read and write SQL required
- Experience analyzing medical, pharmacy, or behavioral health claims is required
- Familiarity with claims coding constructs and data (CPT/HCPCS/Revenue Codes, groupers, EMR, profiling)
- Location Flexible: Maitland, FL; Southington, CT
- Up to 10% travel
What We Offer:
AmTrust Financial Services offers a great work environment, competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical and Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, and Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
AmTrust Financial Services is committed to a policy of Equal Employment Opportunity.