Data Analyst specializing in fraud detection, analysis, and prevention at Payplug. Responsible for key performance indicators and decision - making analyses in payment solutions.
About the role
- Healthcare Data Analyst assessing US Health Insurance policies for compliance. Utilizing analytics to provide insights and strategies for internal teams.
Responsibilities
- Play a critical role in reading, understanding, and assessing the medical and pharmacy policies of US Health Insurance companies
- Conduct detailed reviews of medical and pharmacy policies from various US Health Insurance Companies across Commercial, Medicare, and Medicaid plans and formulary validation
- Assess these policies in the context of our guidelines & criteria such as payer coverage criteria, formulary status, prior authorization (PA), step therapy (ST), and other utilization management (UM) restrictions
- Utilize analytics tools and methodologies to generate insights, providing recommendations for business improvements
- Collaborate with internal teams to strategize and optimize business processes & rules based on analytical findings
- Clearly communicate findings, implications, and recommendations to internal teams and external partners; ensuring complex information is easily interpretable
- Develop and maintain documentation related to policy assessments and compliance activities
- Contribute to the internal initiatives, which includes adhoc projects and employee engagement programs
Requirements
- Bachelor's degree in Life Sciences (Pharmacology, Dentistry, or related field)
- 2 to 5 years of experience in Pharma/Healthcare (pharmacovigilance, insurance, health IT)
- Certification in SQL, Power BI, or similar technical skills is preferred
- Prior experience in the corporate healthcare industry is required
- Experience in healthcare policy, insurance, compliance, or related areas with solid knowledge of US healthcare regulations is highly desirable
- Familiarity with secondary data sources such as FDA databases, Redbook, and clinical labels is preferred
- Strong analytical mindset with keen attention to detail
- Proficient in Microsoft 365 and Google Suite Workspace
- Technical expertise in Excel required
- Working knowledge of SQL and Python or similar programming language is good to have.
Benefits
- Healthcare benefits
- Flexible working arrangements
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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