Healthcare Claims Data Analyst

Senior Healthcare Claims Data Analyst

The Senior Healthcare Claims Data Analyst will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently.

Candidate should have experience and knowledge across a breadth of health care claim domains. This includes Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas. Previous claim payment experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with provider billing practices, claim system limitations, and provider contracting terms are highly recommended. Experience in Pre Pay and Post Pay is recommended/encouraged as well.

*Salary Range for this role is: $93,900 - $154,200

For more information on benefits and what we offer please visit us at

Responsibilities

• Pull and integrate data from disparate sources (e.g. claims, membership/enrollment, etc.)
• Perform quality assurance reviews on data and document the findings
• Interpret, analyze and present key findings to internal team & business partners
• Conduct deal reviews and work with appropriate stakeholders
• Publish the attribution status to all required stakeholders
• Research on issues related to attribution and co-ordinate with required stakeholders to bring it to closure
• Provide user guide and maintain documentation on existing attribution methodology
• Help develop the tools for quality and transparency for attribution
• Become the analytical, technical and business co-lead
• Coding responsibilities will include HIVE, SQL, and Python primarily.

Qualifications

Must have:

• Minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience
• 5-7 years of relevant hands-on data analysis experience
• 5-7 years of relevant medical claim experience across Inpatient, Outpatient, SNF, ESRD, Rehab, Behavioral Health, Home Health, and PBM areas
• Strong Healthcare Insurance data experience
• Experience in using business tools to query large datasets, e.g., SQL, SAS Enterprise Guide, Claris, Pareo, Optum.
• Demonstrates good written and verbal communication skills.
• Able to present information to various audiences – Technical and Non-Technical

Good to have:

• Ability to work with large data sets from multiple data sources.
• Excellent communication skills with strong background working directly with coworkers and clientele to identify business objectives and establish requirements
• Worked in a team environment and also coordinated with business/functional team
• Experience working with Azure Databricks
• Experience with development and/or knowledge of Claims Code Edits
• Knowledge and experience across multiple Claims Systems such as QNXT, Facets, and TOPS

What we offer:

• EXL offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class analytics consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth
• EXL Health Analytics requires different skill sets at different levels within the organization. At EXL Analytics, we invest heavily in training you in all aspects of analytics as well as in leading analytical tools and techniques.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL sets the stage for further growth and development in our company and beyond.

*The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

Required Skills

• Adapting To Change
• Attention To Consistency
• Code Edits
• Healthcare Claims
• Interpersonal Dynamics with Coworkers
• Results Orientation
• Root Cause Analysis
• SQL Analysis
• Statistical Analysis
• Time Management Skills
• Working under Pressure
• Writing Communication Skills

About Us

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.