Manager - Healthcare Analysis (Mega AC)

Job Description

Execute and complete specific deliverables and activities that analyze, validate, and standardize the data-gathering process as well as report statistical data & performance metrics from multiple sources (e.g. insurance processing, performance metrics, clinical operations, demographics, costing reports) in order to fulfill our business and customers' needs.

Healthcare Data Analysis

1. Design data models that integrate patient data from multiple sources to create complete views of health data.
2. Analyze members' health risk segmentation and chronic cases profiling (e.g., chronic disease, cancer, hepatic disease, renal failure).
3. Investigate data to find patterns and trends.

Performance Analysis and Reporting

1. Pull and integrate data from multiple sources.
2. Analyze data to assist in delivering optimal healthcare management and decision making.
3. Publish monthly reports for mega accounts including different dimensions.
4. Develop reports and presentations.
5. Ensure accurate and timely completion of daily and monthly reports of all performance metrics.
6. Communicate analytical insights with management.

Data Cleansing

1. Apply advanced categorization of services with standardized and concise mapping.
2. Ensure proper validation of doctor names in the data, specialties, modifying and validating of the unified service coding process.

Analysis and Reporting Transformation Initiatives

1. Collaborate with the different business units and functions in order to execute the assigned objectives related to big data projects and digital enhancements, transformations, and implementations.
2. Interpret and validate data to be incorporated into advanced analytics and ML models.
3. Automate the manual reports through Power BI.

Skills

1. Intermediate to advanced skill level with MS Excel, PowerPoint, and Power BI.
2. Data Analysis including healthcare claims data manipulation.
3. Ability to interpret both high level and detailed view of the data.
4. Excellent analytical and communication skills.

Education

MBBS (Bachelor of Medicine & Surgery) with some expertise in Insurance is preferred.