Assist in analyzing medical and pharmacy claims data to identify trends, cost drivers, and opportunities for optimization.
Support provider contracting and payer teams by pulling and summarizing data on reimbursement models, pricing structures, and fee schedules.
Assist in building and maintaining financial models to assess payer performance, reimbursement strategies, and cost containment opportunities.
Collaborate with sales and contracting teams to deliver ad hoc data pulls and reports that support growth initiatives.
Work with Medicare, Medicaid, and commercial claims data to support tracking reimbursement trends and regulatory changes.
Build and maintain reports and dashboards using SQL, Power BI, or Tableau to visualize key business metrics.
Support evaluation of the financial impact of alternative payment models, value-based care initiatives, and provider incentives.
Perform quality checks to ensure data integrity and accuracy in claims analysis.
Partner with internal teams to support claims processing workflows, payment accuracy, and operational efficiencies.
Basic familiarity with Medicare and commercial payer reimbursement concepts; willingness to learn reimbursement methodologies on the job.
Exposure to medical and pharmacy claims data or healthcare financial concepts is a plus; training will be provided.
Working knowledge of SQL for data querying; familiarity with Python or R is a plus.
Experience/interest leveraging AI tools to automate workflows.
Any exposure to contract negotiations, network management, or provider relations is a plus.
Strong communication skills and the ability to clearly present data findings to teammates and stakeholders.
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