Job Purpose:
- As part of the Medical Team, the job holder will undertake data analysis, which includes creating triggers, trend analysis, and creative ways of establishing connections between various fields with a view to identifying fraud, waste, and abuse (FWA) in medical claims.
- The job holder will be responsible for collecting, importing, transforming, validating, summarizing, and publishing meaningful claims analysis reports to identify high-risk providers and ultimately lead to preparing claims samples to audit for on-field auditors.
Key Accountabilities:
- Management Information System.
- Sanitize, arrange, analyze, interpret the data, and publish medical audit reports; trending dashboard from time to time/agreed on periodicity.
- Ensure data security and confidentiality.
- Accuracy and attention to detail will be paramount.
- Deal with large amounts of data: facts, figures, and number crunching.
- Present data in dashboards as charts, graphs, and tables as required.
- Constantly evolve new reporting templates as per the business need.
- Work closely with colleagues across the organization to resolve issues as they arise.
- Work closely with the respective team and provide recommendations on automation requirement-related reporting tools to improve reporting tools.
- Periodic team training on Data analysis and Audit sampling.
- Lead the existing data analysts within the audit team and improved skillset and outcome.
Skills Required:
- Jobholder must be energetic and possess the ability to learn quickly in fast paced environment.
- Must have SAS Analytics experience, solid analytical Skills, and data mining aptitude.
- Alteryx knowledge is an additional value.
- Strong attention to detail; high degree of speed and accuracy.
- Strong proficiency in MS office suit (special Excel & PowerPoint).
- Problem-solving capabilities and understanding of basic statistical methods.
- This role requires an understanding of programming logic, although no experience with a specific programming language is required.
- Medical audit & investigation mindset is critical to the role.
Education, Experience, and Formal/Professional Qualifications Essential Skills:
- Degree in Statistics/Mathematics.
- Advanced SAS Analytics knowledge/experience.
- Strong analytical skills and an understanding of system databases, and data elements, must be able to function independently.
- Para-medical background/education.
- Insurance experience.
- Minimum working experience of 4-5 years (1-2 years in UAE), preferably in health insurance.
- Basic knowledge of ICD, CPT, SQL, and Medical Insurance billing in the UAE environment.
