- 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.
PythonSQLMicrosoft Power BI+2 more