Research Analyst – Medical Management

Role Overview

• Identify, develop, and implement solutions to improve accuracy and integrity of claims payments across the Plan.
• Scope PI initiatives and analyze claims data.
• Develop implementation assessment plans and collaborate with internal and external stakeholders.
• Optimize payment processes by leveraging understanding of Providence Health Plan infrastructure and related functions.

Requirements

• Bachelor's Degree, or 3 years equivalent experience.
• 3 years experience with performance improvement/organizational change tools.
• 3 years experience working with large data sets and analytics teams.
• 3 years claims processing experience within the health insurance industry.
• Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices.
• Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design.

Benefits

• Health care benefits (medical, dental, vision)
• 401(k) Savings Plan with employer matching
• Paid parental leave
• Paid vacations
• Paid holidays
• Time off benefits
• Disability insurance
• Life insurance
• Voluntary benefits
• Well-being resources