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Role Description

The Healthcare Data Analyst will be responsible for reviewing and analyzing medical and pharmacy claims data to identify claims risk necessary to optimize the underwriting process. This position will also be responsible for creating and defining best practice standards for reviewing, analyzing and providing claims experience overview to the underwriters, nurses and management.

• Prepare “Shock underwriting Summaries” - Review underwriting group reports to identify and extract data for individuals diagnosed with potentially catastrophic conditions.
• Prepare “Shock underwriting Summary”, providing a sequential synopsis of each individual’s conditions and treatment (ICD-9 or ICD-10 codes), including the range of the dates of service, treatment provided (based on CPT codes), and corresponding costly drugs prescribed under medical and pharmacy plans.
• Isolate and present data corresponding to individuals identified as representing potentially significant risk to Underwriting using ESL System.
• Forward the Shock Claims Summary to underwriters and medical risk consultants for review as part of the stop-loss underwriting risk assessment process.
• Review policy holder terms in ESL Office, such as spec level deductible and Stop Loss Contract type, that may impact risk selection.
• Maintain a process for identifying potential specific claimants within each sold group's utilization data, collaborating with other key departments like Claims.
• Interact with Underwriting, Sales, and MRCs to discuss significant risk findings on new and renewal business experience reports.
• Lead as a resource for medical coding.
• Work on special assignments, such as testing ESL application enhancements and conducting annual “laser project” analysis.

Qualifications

• 3-5 years of cumulative, relevant experience
• College degree or equivalent work experience
• Considerable knowledge of duties typically obtained through job-related training and experience
• Knowledge of specified computer applications; office practices and procedures
• Uses initiative and independent judgment within established procedural guidelines

Requirements

• Employer work visa sponsorship and support are not provided for this role
• Applicants must be currently authorized to work in the United States at hire and maintain authorization throughout employment
• Minimum Internet Speed: 100 Mbps download and 20 Mbps upload
• Internet Type: Fiber, Cable (e.g., Comcast, Spectrum), or DSL
• Not Permissible: Satellite (e.g., Starlink), cellular broadband, or wired dial-up

Benefits

• Flexible full-time or hybrid telecommuting arrangements
• 401(k) plan with immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days, and ten paid holidays
• Company matching for community giving