Senior Complex Resolution Analyst responsible for handling complex OMNI issues and adjustments. Engaging in remediation research projects and coaching lower level professionals for effective operations.
About the role
- Cost of Care Analyst role at Elevance Health applying advanced analytics to drive healthcare insights and innovations. Requires strong quantitative skills and experience in healthcare analytics.
Responsibilities
- Provides analytical insights to support business solution development based on quality, use, cost, and other key drivers
- Develops and refines analysis templates for problem diagnosis and opportunities assessment
- Consults on all considerations related to designing and executing tests or pilot programs
- Contributes to the design of new programs/initiatives based on test/pilot outcomes
- Develops targeting criteria or customer segmentation based on analytical insights, clinical inputs, product design, and operations considerations
- Develops predictive models and other tools that help target the right members
- Develops methodology to measure clinical, utilization, and financial outcomes of a program/initiative
- Conducts in-depth research to address challenging issues in measuring outcomes
- Leads applied research projects
- Authors white papers, presents at industry conferences, and submits journal publications
- Addresses the limitation of certain data sources and evaluates the incremental value of new data sources
Requirements
- Requires MS, MA, or PhD with concentration in a quantitative discipline such as Mathematics, Statistics, Economics, Epidemiology, Engineering, Computer Science or Operations Research
- a minimum of 5 years experience in related health care analytics
- Experience performing trend analysis to identify patterns in healthcare costs over time
- In-depth understanding of healthcare dynamics, including service delivery, reimbursement models, and payer systems
- Experience in healthcare finance or healthcare actuarial analytics
- Substantial analytical experience in the healthcare industry
- Advanced SQL & SAS skills
- Oracle Exadata experience preferred
- Familiarity with AI/ML frameworks
- Additional skills for success are Python, Informatica, Tableau, and/or Power BI
- Experience in using Agile estimation techniques such as Planning Poker, T-shirt Sizing, or the Fibonacci sequence
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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