Florida Blue - Healthcare Reporting/Data Analyst V

Job Summary:

PIO Analysts research, extract and analyze data to facilitate resolution of payment issues. The candidate chosen for this role will work within a

collaborative group of analysts to research and analyze various data sources and attributes (e.g., claims, authorizations, benefits, etc.). Analysts develop

information needed to support data-driven recommendations for claims process improvements and to quantify medical expense savings across PIO.

Analytical experience specific to Florida Blue is uniquely valuable given this role’s emphasis on claims accuracy and related data.

Essential Functions:

These essential functions represent the major duties of this role. Additional duties may also be assigned.

Perform research and analysis of complex healthcare data, applying business experience and knowledge of data analysis.

Create custom reports, programs, and databases to facilitate research and resolution for a wide array of Payment Integrity issues.

Develop defensible saving analyses with sound business and financial rationales.

Rigorously test programs to ensure accurate reporting capability and financial results.

Research, develop, analyze, and interpret data for medical cost and payment accuracy initiatives.

Provide relevant perspective and analytical expertise based on acquired healthcare knowledge.

Consult with Project Managers, Research Analysts, and other requestors to accurately develop data requirements, refine analyses & calculations for

defensible cost savings measurement.

With direction from the PIO Analytics manager, prioritize and perform tasks independently to meet deliverables and deadlines.

Clearly communicate complex information concisely and articulately for various audiences.

Required Experience:

5+ years directly related work experience with health care administrative claims data or equivalent transferrable experience and education

Experience in data extraction/analysis using SQL or SAS in the Unix environment or other report writing tools

Experience Developing Business/data Requirements

Experience in creating, reconciling, summarizing, and analyzing financial and/or medical claims data

Experience with data extraction from multiple large data sources

Experience using MS Excel in the development of reports and summary analyses

Strong oral and written communication skills when communicating complex data analytics

Bachelor’s Degree in healthcare / business-related discipline or additional equivalent work experience

Preferred Experience:

Experience directly related to performing healthcare data analysis, claim processing, claim audit or continuous improvement with a focus on claim payment accuracy

Knowledge of applications, data sources, or systems such as Diamond, Enterprise Data Warehouse (EDW & VOADHOC/DORIS)

Experience with Power BI or Tableau

General Physical Demands;

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.