Marathon Health · 3 hours ago

Claims Analytics Consultant

United States

Full-time

Remote

Mid, Senior Level

$90K/yr - $120K/yr

5+ years exp

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Responsibilities

Collaborate with business stakeholders to understand claims analytics and reporting needs regarding Marathon Health ingestion and use of claims.

Develops reporting to enhance our ability to understand and act upon claims-based information including costs, clinical trends, disease pattern, usage patterns by service type, and other key claims results.

Knowledge and experience working with both medical and Pharmaceutical claims databases.

Acts as the SME in development of a claims database, claims understanding of coding and usage, claims costs and claims analytics.

Helps support the Marathon Health organization in effectively leveraging claims in helping transform lives.

Has solid understanding of the claims processing system in the health plan arena and comprehensive understanding of claims based financial, utilization, and clinical metrics.

Assists teams in creating claims processes that ensure accuracy of claims data, accuracy of the quality review process, a deeper understanding of the QA process for monitoring large claims data sets.

Produce clear and concise summaries of claims insights and analytical findings for easy consumption by a variety of audiences throughout Marathon Health and our external clients.

Responsible for internal reporting as well as ad-hoc data queries and proactive analysis to help support comprehensive understanding of our claims data and warehouses.

Gathers, manages, and synthesize large amounts of information effectively and creatively.

Analyze external/internal claims and clinical data and provides recommendations on improving our claims analytics.

Ensures reports and presentations are visually appealing.

Document process flows and create standard operation procedures for reporting.

Ensures consistency in Marathon Health reporting products.

Other Duties as Assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Health Plan claims experienceSQL/SAS coding skillsHealthcare data understandingData Visualization (Tableau)EDW/Datawarehouse EnvironmentMedical coding familiarityMS Office SkillsLarge Data Sets understandingData synthesis skills