Job Description:
• Analyze the Claims Trends and Cost Analysis, Direct Billing v/s Pay and Claim Ratio
• Price Inflation Study
• Analyze statistical data to determine probability of risks, abuse, waste, fraud or financial impact.
• Create the Provider Score Cards
• Data mining and data analysis are required for conducting investigations on provider claims.
• Analysis of provider performance and compiling deviations per provider type and per network
• Provide early warnings for any risks identified and issue recommendations on corrective measures
• Provide time-sensitive actionable data to enable proactive business decisions and/or to respond appropriately to changing market trends or business environment
• Identify process improvements and streamline data collection and report generation
• Advise the department on the possible impact of variations and involve in developing effective workarounds that would enhance business performance
• Uphold the reputation of company, beneficiaries, payers and all other parties involved
• Participates in specialized projects and assignments related to MPM, as required
• Support and drive the savings target strategy as set by the Global head of MPM and Regional Head.
• Manages and ensures generation of periodic dashboards
• Identify and distill data from varied external and internal sources to address critical priorities outlined by leadership such as undertaking key modeling exercises based on current regional and global trends in areas of interest to MPM.
• Create relevant visualizations and reports analytical findings using innovative methods to promote understanding of key insights for both internal and external audiences (including putting together insightful presentations).
• Develop and test alternative quantitative methodologies and analysis, e.g., segmentation, ranking, spend profiling, gap analysis and trend mapping.
• Understand methods from diverse disciplines (e.g. statistical modeling, data mining, data processing) to ensure the quality of analysis.
• Assist on analysis work when non-standard analyses are needed.
• Train local area managers on quantitative research methods and mentor them as needed on new processes.
• Support multiple projects at the same time and communicate with all relevant project stakeholders
Job requirement:
• 5 years in commercial analytics, market analysis, healthcare management/consulting or other relevant private/public sector experience
• Bachelor’s degree or higher in Finance, Data Analytics or Business degree (data focus)
• Able to use a range of standard (Microsoft Office Suite) and non-standard IT applications to support and enhance the work.
• Mentorship experience with diverse global team of analysts.
• Experience delivering data projects to non-data people, ability to distill complex to simple.
• Ability to work under pressure
• Demonstrated ability to prioritize and follow up.
• Passion for excellence
Key Competencies:
• Outstanding organizational and time management skills;
• Flexible and efficient. Ability to multitask and prioritize daily workload;
• Logical thinking mind set and ability to problem solve;
• Results driven and strategic thinker;
• Effective Business Storytelling
