Claims Recovery Reporting Analyst

Job Description:

Position Summary:
The Claims Recovery Analyst will be responsible for the development of enterprise-wide business reports based on the specific needs of our internal/external clientele to support utilization, medical management, claims payment accuracy, and performance. This position requires a well developed understanding of the health insurance / health care industry, and in-depth understanding of health care data and the methods of data analysis.

General Responsibilities:

  • Create ad hoc and standard reports using various reporting tools for different functional areas of the company.
  • Assess reporting results through data investigation, analysis, and evaluation.
  • Analyze data and trends and create documentation supporting all of the reports.
  • Prepare written analysis and summarize results using graphical representations and professional formatting.
  • Ensure that reports support the overall scope of company's business strategies.
  • Maintain data integrity and ongoing quality control of delivered reports.
  • Work closely with all levels of end users, including executive level staff, to quickly develop reports which will be used to make strategic business decisions.
  • Create detailed documentation outlining report criteria and provide recommendations to the requestor based on the results of the report.
  • Initiate new projects that benefit the goals of the company.
  • Have advanced knowledge of utilization, claims processing procedures, claims payment guidelines and/or fraud, waste and abuse.
  • QA reports for not only coding errors and issues, but also make suggestions on data representation

    Required Education & Work Experience:
  • Bachelor's degree in Computer Science or related field required
  • Minimum 3 years experience as a Report Writer/Analyst
  • Minimum 5 years progressive experience in Information Technology
  • Experience in health plan, medical claims, and SQL required, FACETS preferred

    Required Knowledge, Skills, and Abilities:
  • Strong analytical and problem solving skills and abilities.
  • Ability to interface with multiple users across the organization and effectively project manage reporting requirements from start to finish.
  • Ability to work in a rapidly changing and growth oriented environment with regularly changing priorities and developing opportunities.
  • Demonstrate strong communication (both verbal and written), and customer service skills, and exchange information with others clearly and concisely.
  • Ability to manage own work flow and meet deadlines while responding to frequent demands of multiple customers (internal and external).
  • Take ownership of each project from start to finish and follow-up with management on project status.
  • Extensive professional experience in data analysis and report design/development.
  • Extensive knowledge of reporting programs and tools.
  • In-depth knowledge and experience with relational database concepts and query tools.
  • Sound knowledge of SQL and data extraction methodologies.
  • Strong report presentation skills.
  • Excellent communication and interpersonal skills.

    We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.



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