Sr Claims Analyst

Qualifications

•  Bachelors Degree in Information Systems, Finance, or related field, required. Master s Degree preferred. 
•  Minimum five (5) years experience in analyzing operational process and provider billing/claims data. 
•  Advanced PC literacy with particular emphasis on SAS, SQL, Tableau, MS Excel and MS Access or related database tools. 
•  Strong problem solving and verbal and written communication skills. 
•  Experience in quality and/or root cause analysis. 
•  Knowledge of insurance coding and/or claims experience. 
•  Ability to discuss findings and work with all levels of the organization to achieve results. 
•  Self-motivated with an ability to meet objectives and schedules. 
•  Ability to travel between Northwell Health operational sites, as required.

Job DescriptionPosition Summary: Execute a variety of complex analytical exercises to provide operations and care management with actionable, high quality quantitative information that drives effective business decision making, enables interpretation of current, past and future performance, and identifies opportunities to provider better care for our members, steer services into our network and reduce medical and administrative costs. Responsibilities:1. Conduct rigorous data mining and statistically sound analytical analyses to develop and report high quality actionable and quantitative information that will drive effective and integrated business decision making, enable interpretation of performance trends, and identify new opportunities to reduce unnecessary medical and administrative costs.  2. Create dynamic and highly effective methods of data delivery and provide critical and insightful data.  3. Coordinate with line and support functions to provide the analytical support to critical operational effectiveness initiatives and to identify new opportunities for improvement.  4. Develop process improvement initiatives to increase efficiencies and produce quality metrics in a timely manner.  5. Develop expertise and thought leadership in the area of analytics, business intelligence and reporting and provide new and innovative approaches to business data analysis and interpretation.  6. Work closely with Finance, Care Management operations and support functions to ensure an appropriate level of analytical rigor that supports their decision making processes.  7. Develop and execute presentations and reports for middle and senior management use.  8. Continuously improve the delivery of process performance information to all business partners.  9. Performs related duties, as required.