Performance Analysis & Reporting (TPA)
Skills
About This Role
Role Purpose
Execute and complete specific deliverables and activities that analyze, validate, 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 .. etc) in order to fulfil our business and customers’ needs.
Healthcare Data Analysis
- Design data models that integrate patient data from multiple sources to create complete views of health data.
- Analyse members health risk segmentation and chronic cases profiling (e.g., chronic disease, cancer, hepatic disease, renal failure).
- Investigate data to find patterns and trends.
Performance Analysis and Reporting
- Pull and integrate data from multiple sources.
- Analyze data to assist in delivering optimal healthcare management and decision making.
- Publish monthly reports for mega accounts including different dimensions.
- Develop reports and presentations.
- Ensure accurate and timely completion of daily and monthly reports of all performance metrics.
- Communicate analytical insights with management.
Data Cleansing
- Apply advanced categorization of services with standardized and concise mapping.
- Ensure proper validation of doctor names in the data, specialties, modifying and validating of the unified service coding process.
- Analysis and reporting transformation initiatives:
- Collaborate with the different business units and functions to execute the assigned objectives related to big data projects and digital enhancements, transformations and implementations.
- Interpret and validate data to be incorporated into advanced analytics and ML models.
- Automate the manual reports through power
Skills
- Intermediate to advanced skill level with MS Excel and PowerPoint and Power BI.
- Data analysis including healthcare claims data manipulation
- Ability to interpret both high level and detailed view of the data
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