Centers Plan for Healthy Living

  • Claims Data Analyst

    Job Locations US-NY-Garden City | US-NY-Staten Island
    Posted Date 1 month ago(10/16/2018 1:15 PM)
    # of Openings
  • Overview

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    JOB SUMMARY:                     


    This position provides support for the reporting and analysis needs of the Claims Department which is responsible for the timely processing of claims and Provider customer service. Responsibilities include development of reports that will enable more efficient workflows and processes for department staff, as well as those which will assist management in monitoring, assessing, and evaluating departmental performance. Additionally, this role will provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality performance, reduce claim inventory and improve the customer experience.





    • Assist in the development of key performance indicators related to claim processing and call center performance
    • Generate and distribute weekly/monthly/quarterly departmental reports to management and staff
    • Aggregate and interpret operational, claim data, and call center metrics in order to track and trend identifying opportunities for improvement.
    • Identify trends in data, including those that were not necessarily being activity monitored, which may have an impact on departmental performance and/or impact timeliness and the customer experience. Communicate actionable findings and provide recommendations as appropriate to management.
    • Automate department procedures using Microsoft Access databases, Microsoft Excel spreadsheets, or other appropriate software (e.g., SQL). Work directly with managers and subject matter experts to refine and improve these tools for optimal efficiency and effectiveness.
    • Responsible for creating data definitions, validating data, retrieving data from systems, merging data from multiple sources, participating or reviewing technical documentation, report configuration, and coordinates project efforts as directed in order to achieve desired results. For example, quarterly Medicare Part C Reporting, quarterly vendor audits and annual Medicare Audit Universes
    • Serves as a liaison to other departments (IS, Utilization Management, Provider Contracting, Provider Data Maintenance) that may include report creation, disseminating reports and/or leading the implementation, maintenance, testing and/or functional design of system changes.


    Education and Experience:



    Bachelor’s degree in Computer Science, Business, or other health-related discipline



    Type of Experience      



    • ·Two to five years of analytical experience required. Analytical experience in managed care and/or other healthcare setting strongly preferred.
    • Proficiency in Microsoft Excel and Access or SQL.
    • Must have strong analytical and problem-solving skills.
    • Strong communication skills, including an ability to communicate with staff at various levels, including both front line staff and senior management.



    • Familiarity with claims / encounter data, as well as Medicare / NY State Medicaid reimbursement methodologies preferred.
    • Experience with QNXT or FACETS claims system



    Knowledge and Skills:

    • Effective presentation skills
    • Excellent verbal and written communication skills
    • Must be able to participate in meetings with all levels of management within the organization.
    • Detail oriented, excellent follow up
    • Ability to multi-task in a fast paced environment
    • Must be service oriented, quick learner, team player
    • Appreciation of cultural diversity and sensitivity toward target population


    Physical Requirements:

    The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.


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