Data Insights Specialist

1 week ago

Remote, Oregon, United States The Maxis Group Full time
About The Maxis Group

The Maxis Group is a leading provider of data-driven solutions for the healthcare industry. We are seeking a highly skilled Data Insights Specialist to join our team and contribute to our mission of delivering exceptional results to our clients.

Job Summary

We are looking for a talented Business Intelligence Analyst to join our Managed Care team. As a Business Intelligence Analyst, you will be responsible for analyzing complex business problems and issues using data from internal and external sources to provide insight to decision-makers.

Key Responsibilities
  • Data Analysis: Identify and interpret trends and patterns in datasets to locate influences.
  • Forecasting and Recommendations: Construct forecasts, recommendations, and strategic/tactical plans based on business data and market knowledge.
  • Report Development: Create specifications for reports and analysis based on business needs and required or available data elements.
  • Collaboration: Collaborate with health plan and shared services to modify or tailor existing analysis or reports to meet their specific needs.
  • Presentations: May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action.
  • Data Validation: Responsible for accurate and timely identification of critical information on configuration and claims databases.
  • Knowledge Management: Maintains critical knowledge on configuration and claims databases.
  • System Oversight: Oversees operational and claims systems and application of business rules as they apply to health plan.
  • Data Quality: Validates data to be housed on databases and ensures adherence to business and system requirements of health plan as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
  • Configuration Analysis: Analyze and interpret data to determine appropriate configuration changes.
  • Business Requirements: Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
  • System Maintenance: Oversees coding, updating, and maintaining benefit plans, provider contracts, fee schedules, and various system tables through the user interface.
  • Claim Resolution: Applies previous experience and knowledge to research and resolve claim/encounter issues, pended claims, and update system(s) as necessary.
  • Work Prioritization: Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community.
  • Problem-Solving: Provides analytical, problem-solving foundation including definition and documentation, specifications.
  • Process Improvement: Recognizes, identifies, and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
  • Data Evaluation: Reviews, researches, analyzes, and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.
  • Root Cause Analysis: Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.
  • Business Workflow Analysis: Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met.
  • User Documentation: Prepares high-level user documentation and training materials as needed.
  • Continuous Improvement: Works to identify opportunities for continuous improvement, standardization, and reduction of rework across health plan and shared services.
  • Strategic Objectives: Monitors, coordinates, and communicates the strategic objectives of health plan across shared services to optimize performance/results.
  • Data Analysis: Aggregates and assists with the analysis of health plan and shared service data.
Requirements
  • Experience: 2-5 years of experience in a related field, including 1-3 years of formal training in Business Analysis and/or Systems Analysis.
  • Education: Bachelor's degree or equivalent combination of education and experience.
  • Skills: Strong analytical and problem-solving skills, excellent communication and collaboration skills, and proficiency in data analysis and reporting tools.

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