Specialist, Claims Analytics

Job Purpose:

• As part of the Medical Team, the job holder will undertake data analysis, which includes creating triggers, trend analysis, and creative ways of establishing connections between various fields with a view to identifying fraud, waste, and abuse (FWA) in medical claims.
• The job holder will be responsible for collecting, importing, transforming, validating, summarizing, and publishing meaningful claims analysis reports to identify high-risk providers and ultimately lead to preparing claims samples to audit for on-field auditors.

Key Accountabilities:

• Management Information System.
• Sanitize, arrange, analyze, interpret the data, and publish medical audit reports; trending dashboard from time to time/agreed on periodicity.
• Ensure data security and confidentiality.
• Accuracy and attention to detail will be paramount.
• Deal with large amounts of data: facts, figures, and number crunching.
• Present data in dashboards as charts, graphs, and tables as required.
• Constantly evolve new reporting templates as per the business need.
• Work closely with colleagues across the organization to resolve issues as they arise.
• Work closely with the respective team and provide recommendations on automation requirement-related reporting tools to improve reporting tools.
• Periodic team training on Data analysis and Audit sampling.
• Lead the existing data analysts within the audit team and improved skillset and outcome.

Skills Required:

• Jobholder must be energetic and possess the ability to learn quickly in fast paced environment.
• Must have SAS Analytics experience, solid analytical Skills, and data mining aptitude.
• Alteryx knowledge is an additional value.
• Strong attention to detail; high degree of speed and accuracy.
• Strong proficiency in MS office suit (special Excel & PowerPoint).
• Problem-solving capabilities and understanding of basic statistical methods.
• This role requires an understanding of programming logic, although no experience with a specific programming language is required.
• Medical audit & investigation mindset is critical to the role.

Education, Experience, and Formal/Professional Qualifications Essential Skills:

• Degree in Statistics/Mathematics.
• Advanced SAS Analytics knowledge/experience.
• Strong analytical skills and an understanding of system databases, and data elements, must be able to function independently.
• Para-medical background/education.
• Insurance experience.
• Minimum working experience of 4-5 years (1-2 years in UAE), preferably in health insurance.
• Basic knowledge of ICD, CPT, SQL, and Medical Insurance billing in the UAE environment.