Medicare Business Analyst

Analytical support to the Government Programs business unit by extracting data and analyzing claims, enrollment and general health insurance data. Responsible for the extraction, modeling, preparation and analysis of information for use by Government Program management for decision-making. This information is often used to affect product and benefit design. REPRESENTATIVE JOB DUTIES (listed in order of importance):Design and model data extractions and provide comprehensive assessments of trends and data errors and other relevant information to assist in the product development and oversight process of the Government Programs unit. Evaluate studies and data requests including comprehension of the methodologies laid out and discussed and understanding the objective of the request for information. Because information worked with is less than perfect, an approach must be developed to best capture the information. Understand the methodology, assumptions, and the qualifications that will be required to capture the desired information.Communicate effectively with the other analytical staff and management. Write memos that are clear and concise. Identify issues and problems with the analysis and communicate to management.Create reports and spreadsheets that display the results in a logical and concise manner including presentations that are given to Government Programs management. Participate in meetings by verbally expressing technical information in a way that can be understood by technical and non-technical staff. May be expected to represent the department in meetings throughout the corporation.Design and write computer programs using data extraction tools to extract appropriate data from the various databases. This includes the testing of the program and the data extracted against the control sources available. Utilize PC and available software to develop a meaningful and well thought out analysis. Share expertise and offer technical guidance to other departments. Recognize data problems, recommend potential solutions and implement those solutions.Research and understand medical expense concepts, particularly as related to medical and pharmacy costs and utilization.KNOWLEDGE, SKILLS & ABILITIES REQUIRED:Knowledge of:BCBSRI business processesLRSP and other system expertiseGovernment healthcare programs (Medicare, Medicaid). Technical Skills:High level of computer proficiency.Development and use of PC applications for data analysis, specifically spreadsheet and data base systems. Ability to perform basic programming, program design and development using SAS (preferred)Written and verbal communication skillsAbility to learn new softwareStrong analytical skillsStrong teamwork skills Ability to:Work independently.Handle multiple priorities.Exercise sound judgment.Take initiative in finding solutions to difficult and/or sensitive problems.Perform other duties as assigned.QUALIFICATIONS:Minimum Education and Experience:Bachelor’s degree in Mathematics, Computer Programming, Economics, or Business.3-5 years of work experience in health data analysis or a related field. Graduate level training in Mathematics, Economics, or Statistics will be considered in lieu of formal working experience.Must achieve a score of 80 or higher on the Wolf-Spence Programming aptitude test. Must have data extraction experience using mainframe and server application.Preferred Education, Additional Qualifications and Experience:Knowledge on mainframe or Personal Computer application Software is preferred such as spreadsheets, Windows and data extraction tools. Health Care experience is desirable. REASONING & PROBLEM SOLVING:Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.Ability to compute ratios, and percentages and interpret and draw conclusions from numerical data.Ability to critically read documents and interpret and draw conclusions from written data.Ability to apply common sense understanding to carry out detailed and involved verbal instructions.Ability to resolve problems involving several concrete variables in non-standard situations.BUSINESS IMPACT & SCOPE (Decision authority or quantifiable job requirements):Determine on the mathematical or statistical method to use in analysis. Determine the best tools to obtain desired results (computer hardware software etc.) Determine the appropriate qualifications for the data analysis.Determine the best source of information available.Provides information to management at all levels, often providing data affecting the decisions and control of up to hundreds of millions of dollars in premium revenue. Identify trends and contribute to the development of new products and benefits. Provides input used to evaluate claims initiatives, with third party vendors. Provide input for decisions to undertake a corporate strategy to launch or cancel a program.WORK ENVIRONMENT & PHYSICAL DEMANDS:Work Environment:Works in typical office environment. Moderate noise levels may affect ability to concentrate.Handling and being exposed to confidential information.Ability to handle multiple tasks concurrently.Physical Demands:Frequent sitting, standing, and walking.Frequent talking and listening.Frequent walking to other buildings for presentations and meetings.Close vision and ability to adjust focus to read and view computer screen.Ability to occasionally lift and carry up to 20 pounds without assistance.At Blue Cross & Blue Shield of Rhode Island, diversity & inclusion strengthen our ability to meet the challenges of today’s healthcare industry. We are an equal opportunity employer.-see job description