Performance Analysis & Reporting (TPA)

Job Description

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