Healthcare Data Analyst

Symetra is a national financial services company dedicated to helping people achieve their financial goals. The Healthcare Data Analyst will be responsible for reviewing and analyzing medical and pharmacy claims data to identify claims risk, optimizing the underwriting process, and providing insights to underwriters and management.

Responsibilities:

• Prepare “Shock underwriting Summaries” - Review underwriting group reports in order to identify and extract data corresponding only to individuals diagnosed with potentially catastrophic conditions
• Prepare “Shock underwriting Summary”, which provides a sequential synopsis of each individual’s conditions and treatment (ICD-9 or ICD-10 codes), including the range of the dates of service on the report, the treatment provided (based on CPT codes) and the corresponding costly drugs prescribed under medical plan (HCPCS-Codes ) and as well as under pharmacy plan (PBM reports) For each group, the data corresponding to the individuals who are identified as representing potentially significant risk needs to be isolated and presented to Underwriting using ESL System
• The Shock Claims Summary will be forwarded to the underwriters and the medical risk consultants for review as part of the stop-loss underwriting risk assessment process
• Review policy holder terms in ESL Office like spec level deductible, Stop Loss Contract type, and other factors that may impact the risk selection
• Maintain a process for identifying potential specific claimants within each sold group's utilization data including collaboration with other key departments like Claims to identify and monitor specific claimants in a timely fashion
• Customer Service Goal Details: Interact with Underwriting, Sales and MRCs in order to discuss significant risk findings on the new and renewal business experience reports. Lead as resource for medical coding
• Special projects/assignments - Works on special assignments, such as testing of the ESL application enhancements, conduct annual “laser project” analysis, testing external applications as needed

Requirements:

• 3-5 years of cumulative, relevant experience
• College degree or equivalent work experience
• Requires considerable knowledge of duties typically obtained through job-related training and experience
• Knowledge of specified computer applications; office practices and procedures
• Uses initiative and independent judgment within established procedural guidelines