Senior Analyst, Claims, SQL

Job Description: • Contribute to the Payment Integrity program by partnering with internal team members and business areas enterprise wide to identify mis-paid claim opportunities • Understand and compile claim criteria, write Structured Query Language/GoogleSQL (SQLs) to pull claim data, perform reviews of potential opportunities, analyze claim data, identify trends, and write requirements for accurate validation of claims • Query Development - Write Structured Query Language/GoogleSQL (SQLs) to extract claim data from various sources • Assemble data from various sources • Use creative problem solving and critical thinking to overcome complications and inconsistencies in the data and writing the SQL • Collaboration - Create collaborative working relationships with team members and business partners to troubleshoot, create, and refine processes and queries • Translate claim knowledge into identifiable criteria to write accurate SQLs • Data Analysis - Organize and manipulate large data sets to identify key components of incorrect claim payments and identify trends • Identify relationships between data elements and how those relationships impact the task • Recognize trends and outliers; draw insights from trends and test those insights • Perform reviews of potential Medicaid incorrect payment opportunities • Process & Procedure - Use documented Standard Operating Procedures (SOP) and create new SOPS as necessary for changes and additions to business processes • Identify practical solutions to address process gaps • Meet or exceed standard TATs • Work independently • Keep multiple work tasks moving at the same time • Keep pace with a fast-moving environment where priorities may change frequently and quickly • Participate or lead ongoing opportunities to progress the Payment Integrity program Requirements: • Must have QNXT claim system/processing knowledge • Must be experienced in writing code (BQL) in GCP, including joining multiple tables, subqueries, and casting • Proven track record of meeting deadlines • Advanced level of data manipulation • Excellent problem-solving skills • Outstanding verbal and written communication • Detail and solution oriented • Intuitive data analysis skills • Inductive and deductive reasoning skills • Strong analytical and investigative skills • Demonstrated ability to transform raw data into actionable items Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Apply tot his job Apply To this Job