Health Management Data Analyst

Requirements:

• Must have: 25 years of US Healthcare experience dealing with health and welfare plans ideally gained in a benefits consulting/brokerage firm Health Plan Third Party Administrator Regulatory Agency Legal/Compliance Firm or insurance company
• Must have: Experience in utilization background and managed care is required.
• Must have: Skills in data and numerical analysis as well as basic data visualization are necessary
• Statistical skillset use of tools and Excel are required (PowerBI preferred).
• Must have: Clinical data background with a focus on analysis.
• US Registered Nurse or LCSW with active license preferred
• Health analytics experience preferred
• Understanding of health plan utilization/case management processes network management credentialing quality management pharmacy priorauthorization processes and health plan operations
• Basic understanding of Mental Health Parity and Mental Health Parity NonQualitative Treatment Limits
• Strong written and verbal communication skills
• Amenable to working on a night shift (US) schedule.
• Amenable to work in a hybrid setup (2x WFH/week) in BGC Taguig

The Role

will work on data from various insurance sources including credentialing and quantitative analysis. Manage NQTL operational data portion of parity assessment including:

• Prepare NQTL carrier operational data requests on behalf of each client/carrier
• Coordinate with Project Manager regarding sending requests timing status and followup
• Attend internal and client kickoff meeting with the QTL/NQTL team
• Monitor carrier and vendor responsiveness to data requests
• Validate completeness of response and report any issues or impact on the timeline proactively to the Project Manager
• Complete initial review of carrier responses for parity projects
• Map carrier responses to the appropriate section of the NQTL document
• Cite specific references criteria and example(s) for each response
• Draft gap analysis based on documents reviewed including master templates and clientspecific responses
• Collaborate with health management senior reviewer and Project Manager to conduct followup calls/emails with carriers/vendors as needed for clarification and submission of additional documentation
• Support the overall completion of the NQTL operational data component of the report
• Schedule meetings and coordinate efforts of colleagues
• Participation in weekly or biweekly project status calls as needed
• Participate in MHPAEA office hours as needed
• Maintain materials/documentation in a manner consistent with the company work processes and peer review standards (e.g. filing of drafts deliverables client and carrier documentation)

Remote Work :

No