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 Provider Network 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
  • Identify and Interpret Trends: Identify and interpret trends and patterns in datasets to locate influences.
  • Construct Forecasts and Recommendations: Construct forecasts, recommendations, and strategic/tactical plans based on business data and market knowledge.
  • Create Specifications for Reports: Create specifications for reports and analysis based on business needs and required or available data elements.
  • Collaborate with Stakeholders: Collaborate with health plan and shared services to modify or tailor existing analysis or reports to meet their specific needs.
  • Present and Interpret Analysis Results: May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action.
  • Validate Data: Responsible for accurate and timely identification of critical information on configuration and claims databases.
  • Maintain Critical Knowledge: Maintains critical knowledge on configuration and claims databases.
  • Oversee Operational Systems: Oversees operational and claims systems and application of business rules as they apply to health plan.
  • Validate Data Adherence: 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.
  • Analyze and Interpret Data: Analyze and interpret data to determine appropriate configuration changes.
  • Accurately Interpret Business Requirements: Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
  • Oversee Coding and Updating: Oversees coding, updating, and maintaining benefit plans, provider contracts, fee schedules, and various system tables through the user interface.
  • Apply Analytical Skills: Applies previous experience and knowledge to research and resolve claim/encounter issues, pended claims, and update system(s) as necessary.
  • Prioritize Work: Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community.
  • Provide Analytical Foundation: Provides analytical, problem-solving foundation including definition and documentation, specifications.
  • Recognize and Document Changes: Recognizes, identifies, and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
  • Review and Analyze Data: Reviews, researches, analyzes, and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.
  • Conduct Analysis and Identify Root Cause: Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.
  • Analyze Business Workflow: Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met.
  • Prepare User Documentation: Prepares high-level user documentation and training materials as needed.
  • Identify Opportunities for Improvement: Works to identify opportunities for continuous improvement, standardization, and reduction of rework across health plan and shared services.
  • Monitor and Communicate Strategic Objectives: Monitors, coordinates, and communicates the strategic objectives of health plan across shared services to optimize performance/results.
  • Aggregate and Analyze Data: 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, ability to work with complex data sets, and excellent communication and collaboration skills.

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