Associate Data Analyst

Job Description Summary

This role is expected to become a subject-matter expert on the organization, the Plans it supports, plan operations and functions, related regulatory requirements, and operational and regulatory reporting, including CMS audit universes. This role will assess the ability of others to investigate and address all aspects of the grievances, as well as monitor for adherence with company procedures and regulatory requirements.

Job Description

Primary Responsibilities

• Utilizes quantitative and qualitative analysis techniques within multiple domains and factors to assess case work, including data integrity (accuracy), case handling (appropriateness), documentation (precision), and resolution (completeness). Continues to dig for information beyond typical sources of data to validate data.
• Independently researches issues, assesses different data sets, derives common themes or trends, identifies specific risk factors, determines solutions, applies mitigation strategies to various scenarios identified in the data, and communicates with leadership and the broader organization. Demonstrates sufficient knowledge of complaint and understanding of related plan processes or functions to adequately articulate issue and resolution. Serves as primary point of contact for identified trends and issues.
• Employs innovative strategies and solutions to build team capabilities.
• Proactively identifies areas of improvement for self and the department and participates in the development and completion objectives and performance improvement initiatives.
• Ensures grievance resolution reflects the member’s complaint and accurately and completely addresses all components of the complaint.
• Develops and maintains various operational performance metrics to assess productivity and quality. Employs multiple monitoring techniques, methodologies, formats, and best practices to monitor and report on production metrics including volume, aging, and investigation status. Offers mentoring and best practices on investigative processes and case documentation.
• Builds and maintains good rapport and works effectively with individuals in all areas of the company, including working to identify the potential for broader impact and appropriate corrective actions for identified issues.
• Recognizes urgent and sensitive issues/incidents and escalates to management in a timely manner to facilitate appropriate and timely response.
• Communicates the status of assignments to leadership and team in weekly internal meetings for discussion and decision-making.

Qualifications

• Bachelor’s degree & 1+ years of related data analytics experience; Experience in Medicare Advantage, Appeals & Grievances, and/or other health plan operations (e.g., Claims, Customer Service, Enrollment) can be beneficial
• Basic expertise in analyzing data and working knowledge of analytical tools (e.g. Excel, Access, or other database and management systems)
• Strong sense of urgency and flexibility with the ability to prioritize competing priorities to meet tight deadlines, multi-task, and operate effectively in both remote and in-person settings
• Good judgement, logical, analytical, critical thinking, and problem-solving skills with the ability to take on moderately complex problems and achieve a solution within a reasonable amount of time
• Investigatory skill; ability to organize, analyze, and effectively determine risk and appropriate response; ability to remain objective and separate facts from opinions
• Effective oral and written communication, interpersonal and customer service skills; ability to interact with individuals at all levels and personalities
• Energetic, persistent, and forward thinking with high ethical and professional standards
• Good learning agility with the willingness to become a subject matter expert and thought leader

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands, and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.