Healthcare Data Analyst

Symetra

7d • $30 - $50 • Hybrid

About The Position

The Healthcare Data Analyst will be responsible for reviewing and analyzing medical and pharmacy claims data to identify claims risk necessary to optimize the underwriting process. This position will also be responsible for creating and defining best practice standards for reviewing, analyzing and providing claims experience overview to the underwriters, nurses and management. Typical duties include data reporting, data analytics, and data mining, as well as coordinating with relevant departments to determine areas for analysis and the appropriate metrics to ensure data analysis is optimally useful. This position will leverage clinical expertise and system data manipulation skills in order to review large, complex reports and identify individuals with potentially catastrophic claims.

Requirements

• 3-5 years of cumulative, relevant experience
• College degree or equivalent work experience.
• Requires considerable knowledge of duties typically obtained through job-related training and experience.
• Knowledge of specified computer applications; office practices and procedures. Uses initiative and independent judgment within established procedural guidelines.

Responsibilities

• Prepare “Shock underwriting Summaries” - Review underwriting group reports in order to identify and extract data corresponding only to individuals diagnosed with potentially catastrophic conditions.
• Prepare “Shock underwriting Summary”, which provides a sequential synopsis of each individual’s conditions and treatment (ICD-9 or ICD-10 codes), including the range of the dates of service on the report, the treatment provided (based on CPT codes) and the corresponding costly drugs prescribed under medical plan (HCPCS-Codes ) and as well as under pharmacy plan (PBM reports) For each group, the data corresponding to the individuals who are identified as representing potentially significant risk needs to be isolated and presented to Underwriting using ESL System
• The Shock Claims Summary will be forwarded to the underwriters and the medical risk consultants for review as part of the stop-loss underwriting risk assessment process.
• Review policy holder terms in ESL Office like spec level deductible, Stop Loss Contract type, and other factors that may impact the risk selection.
• Maintain a process for identifying potential specific claimants within each sold group's utilization data including collaboration with other key departments like Claims to identify and monitor specific claimants in a timely fashion.
• Customer Service Goal Details: Interact with Underwriting, Sales and MRCs in order to discuss significant risk findings on the new and renewal business experience reports. Lead as resource for medical coding.
• Special projects/assignments - Works on special assignments, such as testing of the ESL application enhancements, conduct annual “laser project” analysis, testing external applications as needed.

Benefits

• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days and ten paid holidays
• Give back to your community and double your impact through our company matching

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level