Job Summary:
Prior experience analyzing Claims and Encounters data is required to be considered for this position.
The Operations Reporting Data Analyst III partners with Operations team to develop and continually evaluate the effectiveness of operational work and provide actionable reporting to meet the business need.
Essential Functions:
- Create reports and analyze data pertaining to trending of operational issues and functions
- Review and analyze Operational reports/KPIs being generated by the Operations groups for accuracy and consistency
- Identify and quantify data issues within Operations and assist in the development of plans to resolve data issues
- Create dashboards and other data visualization tools that provide actionable data to leadership team.
- Transform data analysis and present findings in a consumable, appealing, and impactful executive level format
- Incorporate critical thinking skills and judgment in the process to determine best course of action for each inquiry/problem
- Investigation of claims, encounters, provider, configuration, appeals, and other data that shows a pattern or indicates a significant variation from expected
- Represent the Operations Data team in project meetings to provide data solutions
- Lead multiple projects at same time
- Identify, design, and implement internal process improvements, automating manual processes including repeat report scheduling and self service report development, optimizing data delivery
- Perform any other job-related instructions as requested
Education and Experience:
- Bachelor’s Degree or equivalent years of relevant work experience is required
- Experience in working with business partners and source systems on requirement gathering
- Minimum of five (5) years of experience in data or business analysis is required
- Minimum of three (3) years of experience using at least two from the following is required - SQL, SAS, SSIS, Power BI
- Proficiency in Excel
- Minimum of three (3) years of experience working in healthcare
- Healthcare delivery and/or payer experience preferred
- Experience in data mapping preferred
Competencies, Knowledge, and Skills:
- Proficiency in T/PL-SQL, SAS, PowerBI, SSIS or equivalent
- Proficiency in Excel
- Proven understanding of database relationships
- Graphic development/presentation skills strongly preferred
- Data analysis and trending skills
- Critical listening, decision making, and analytical skills
- Knowledge of managed care
- Working knowledge of the Facets back-end database
- Encounter data submission knowledge preferred
- Understanding of claims operations specifically related to managed care preferred
- Strong written and verbal communication skills
- Strong interpersonal skills and high level of professionalism
- Effective problem solving skills with attention to detail
- Ability to work independently and within a team environment
Licensure and Certification:
- SQL Server, SAS or Power BI certification is preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$70,800.00 - $113,200.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Create an Inclusive Environment
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Top Skills
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits.
CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf
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