Data Analyst - Claims

Job Number: 6979

Workplace Type: Fully Remote

Position Title: Data Analyst

External Description:

As a Data Analyst - Claims with expertise in medical claims, you will be responsible for analyzing, interpreting, and presenting data related to medical claims to support decision-making and operational efficiency. You will work closely with cross-functional teams to identify trends, generate reports, and develop strategies to enhance claims management and processing.

Key Responsibilities:

Data Analysis & Reporting:

• Analyze large datasets related to medical claims, including billing codes, patient demographics, and claim status.
• Develop and maintain reports and dashboards that provide insights into claims trends, processing times, and reimbursement rates.
• Identify and address discrepancies in data, ensuring accuracy and completeness.

Claims Management:

• Evaluate and interpret medical claims data to identify patterns, anomalies, and areas for improvement.
• Collaborate with claims processors and medical coders to resolve issues and optimize claims processes.
• Monitor and assess the impact of changes in regulations, policies, and procedures on claims processing.

Data Visualization:

• Create visualizations to communicate findings effectively to stakeholders, including charts, graphs, and dashboards.
• Present data-driven recommendations to management and other departments.

Cross-Functional Collaboration:

• Work with IT and software development teams to ensure the integration of claims data into analytical tools and systems.
• Assist in the development and implementation of data-related policies and procedures.

Compliance & Quality Assurance:

• Ensure that data handling and analysis comply with relevant regulations and standards, including HIPAA and other data protection laws.
• Conduct regular quality checks to maintain data integrity and accuracy.

Qualifications:

• Education: Bachelor’s degree in Data Science, Statistics, Computer Science, Health Informatics, or a related field. Advanced degree or relevant certifications (e.g., Certified Health Data Analyst (CHDA)) preferred.

Experience:

• Proven experience as a Data Analyst, preferably with a focus on medical claims or healthcare data.
• Strong understanding of medical billing codes (e.g., ICD, CPT, HCPCS) and claims processing workflows.
• Experience with data analysis tools and software (e.g., SQL, Excel, Tableau, Power BI).

Skills:

• Proficient in data analysis, statistical methods, and data visualization techniques.
• Excellent problem-solving skills and attention to detail.
• Strong communication skills, with the ability to present complex data in a clear and actionable manner.
• Ability to work independently and as part of a team in a fast-paced environment.

Preferred Attributes:

• Knowledge of healthcare regulations and compliance standards.
• Familiarity with Electronic Health Record (EHR) systems and their data structures.
• Experience with data integration and ETL processes.

Pay Range: $100,000 - $120,000 annually.

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Data Analyst - Claims

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].