BODS Developer

We are seeking a highly skilled BODS Developer to join our team at Omni Inclusive. The successful candidate will be responsible for developing, implementing, and validating utilization and cost models which characterize providers' claims submissions and treatment patterns.

• Develop and implement utilization and cost models to analyze providers' claims submissions and treatment patterns.
• Determine if dentists are meeting the terms of participation in provider networks throughout the Enterprise.
• Analyze data from Enterprise repositories for recruitment purposes.
• Perform queries, maintain database integrity, and collect data for ad-hoc request reports and documentation.
• Prepare compensation reports and actuarial requests for compensation comparisons and analysis.
• Review and prepare reports, compile statistics, and analyze data regarding dentists requesting compensation changes.
• Coordinate collection of internal data for investigation of irregularities and respond to internal investigative requests.
• Assist with onsite investigations into cases of suspected fraud or misrepresentation.
• Keep abreast of network infrastructure and leverage data sets to meet Enterprise business requirements.
• Review profiling parameters for statistical validity and recommend adjustments.
• Support Client Acceptance Testing of Enterprise-approved business applications.
• Troubleshoot and suggest improvements to systems and software applications.
• Develop and test new utilization models based on claims data from MetaVance.

• Bachelor's degree or equivalent education preferred.
• Minimum 3 years' experience in business, data collection/coordination, and analysis in areas of investigation and/or claims review processing.
• Detail-oriented with research, analytical, and problem-solving abilities.
• Strong organizational/time management and project management skills.
• Basic knowledge of generally accepted accounting principles.
• Strong mathematical skills and ability to perform complex statistical calculations.
• Knowledge of health care industry issues preferred.
• Knowledge of Enterprise products, policies, claims, eligibility, and underwriting guidelines and procedures.
• Knowledge of Enterprise systems, including Business Objects, MetaVance, AS400, and reporting tools.
• PC literacy required; MSOffice skills and knowledge of other Enterprise analytical systems.