Claims Analytics Consultant
Healthstat, Inc

Job Info

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Marathon Health is a leading provider of advanced primary care in the U.S., serving 2.5 million eligible patients through approximately 630 employer and union-sponsored clients. Our comprehensive services include advanced primary care, mental health, occupational health, musculoskeletal, and pharmacy services, delivered through our 680+ health centers across 41 states. We also offer virtual primary care and mental health services accessible in all 50 states. Transforming healthcare delivery with a patient-first approach, we prioritize convenient access to both in-person and virtual care, resulting in improved health outcomes and significant cost savings. Committed to inclusivity and collaboration, we foster a positive work environment and recruit exceptional talent to ensure expertise and compassion in healthcare delivery. Marathon has been recognized as a five-time Modern Healthcare Best Places to Work in Healthcare winner and a six-time Best in KLAS award winner for employer-sponsored healthcare services.

ABOUT THE JOB

The Claims Analytics Consultant will focus on helping the business understand, monitor, and leverage medical and Rx healthcare claims to enhance Marathon Health in transforming lives. The candidate will do this with strong analytic approaches in gathering claims data to solve problems, helping to support the development of the optimal claims ingestion process, providing quality assurance techniques, and monitoring claims for accuracy and completeness.

The claims analytics consultant will hold accountability for insuring claims are accurate and quality assurance processes are put in place and followed. They will be responsible for assisting in developing optimal quality assurance processes, and the first point of contact for all departments with management of claims data issues. They will leverage their analytics, technical, and healthcare claims experience to create and maintain a comprehensive Marathon Health process for leveraging claims information effectively.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Collaborate with business stakeholders to understand claims analytics and reporting needs regarding Marathon Health ingestion and use of claims.
• Develops reporting to enhance our ability to understand and act upon claims-based information including costs, clinical trends, disease pattern, usage patterns by service type, and other key claims results.
• Knowledge and experience working with both medical and Pharmaceutical claims databases.
• Acts as the SME in development of a claims database, claims understanding of coding and usage, claims costs and claims analytics.
• Helps support the Marathon Health organization in effectively leveraging claims in helping transform lives.
• Has solid understanding of the claims processing system in the health plan arena and comprehensive understanding of claims based financial, utilization, and clinical metrics.
• Assists teams in creating claims processes that ensure accuracy of claims data, accuracy of the quality review process, a deeper understanding of the QA process for monitoring large claims data sets.
• Produce clear and concise summaries of claims insights and analytical findings for easy consumption by a variety of audiences throughout Marathon Health and our external clients.
• Responsible for internal reporting as well as ad-hoc data queries and proactive analysis to help support comprehensive understanding of our claims data and warehouses.
• Gathers, manages, and synthesize large amounts of information effectively and creatively.
• Analyze external/internal claims and clinical data and provides recommendations on improving our claims analytics.
• Ensures reports and presentations are visually appealing.
• Document process flows and create standard operation procedures for reporting.
• Ensures consistency in Marathon Health reporting products.
• Other Duties as Assigned

QUALIFICATIONS

Bachelor's degree in a directly related field and 5-7 years of professional experience working with Health Plan claims. SQL/SAS coding skills are required. Strong understanding of healthcare data and possess the ability to communicate complex information to multiple levels of internal/external individuals. Preferred familiarity with Medical coding.

• Understanding of EDW/Datawarehouse Environment
• Tableau/Data Visualization
• MS Office Skills including PowerPoint, Excel, Word

DESIRED ATTRIBUTES

• Understanding Large Data Sets
• Must have health plan claims experience
• Communication to multiple levels of an internal/external organization
• Ability to present complex information effectively.
• Strong data visualization techniques
• Ability to handle multiple high priority requests effectively

Pay Range: $90,000 - $120,000/yr

The actual offer may vary dependent upon geographic location and the candidate's years of experience and/or skill level.

We are accepting applications for this position until a final candidate has been selected. To apply to this position and learn more about open jobs at Marathon Health, visit our careers page.

Marathon Health Benefits Summary

We believe in empowering teammates to do their best work and build better healthcare. Below are some of our benefit offerings. Eligibility is based on 24/hr week. For more information, visit our careers page.

• Health and Well-Being: Free Marathon Health membership for in person and virtual care, employer paid life and disability insurance, and choice in medical/dental plans, vision, employer funded HSA, FSA, and voluntary illness, accident and hospitalization plans. Benefits are effective on the first of the month following date of hire.
• Financial Support: Competitive compensation, 401k match, access to financial coaching through our Employee Assistance Program
• Lifestyle: Paid time off for vacation, sick leave, and more, holiday schedule

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