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Director, Claims Analytics Job
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| Employer Name: |
SpiderID: 13250157 |
| Location: San Francisco, California |
Date Posted: 2/22/2023 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17002IQ-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
The Director, claims analytic is responsible for provide data and analytic support to improve the accuracy and speed of claims processing and to reduce billing errors, fraud and waste. This position reports to VP, Enterprise Analytics and Informatics with dotted line to VP, Claims Operations.
The Director, leads a team of analysts, collaborates with claims operations team to identify ways to measure productivity, to develop a process processes claims processing has in-depth understanding of how information is consumed, and how analytics support all types of business functions in the organization. He/she collaborates with Data Services Organization to plan and to deliver the analytic data platform.
Specific duties include, but not limited to:
- Identifies operational metrics of productivity, accuracy, speed of claims processing.
- Produces routine operational metrics; Develops control charts to identify special cause variation
- Analyzes the process data to identify improvements that will result in better productivity, accuracy and speed.
- Applies advanced analytic tools to identify patterns of billing errors, fraudulent billing, or waste.
Qualifications:
- Bachelor's degree in health care administration, business administration, public health, economics, statistics, computer science, finance, or a relevant field. Master's preferred.
- Minimum 5 years of analytic experience supporting functional areas (finance, network management, medical management) in health insurance industry.
- Minimum 5 years of hands-on experience in data analysis tools, including but not limited to SAS, SQL, SPSS, Access, Cognos, Tableau.
- Minimum three years of supervisory experience leading an analytics/ research team.
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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