We are a first-to-market AI platform that serves the healthcare industry with a focus on health plans. We are a startup with a strong runway!
What you will be doing:
-Responsible for conducting comprehensive analysis of insurance datasets, repricing claims, assessing member disruption risks, designing plans using claims and third-party data, applying risk modeling tools for healthcare cost projections, and utilizing machine-readable files to support underwriting and quoting strategies for self-insured health plans.
-Utilize insurance carrier uniform datasets to conduct discount analyses and evaluate network pricing strategies.
-Reprice medical and pharmaceutical claims to assess network strength and performance for clients across various markets.
-Conduct network strength analyses to evaluate member disruption risk and support client decision-making.
-Design sophisticated benefit plans, incorporating claims data and third-party data sources to evaluate provider cost and quality performance and develop network tiers.
-Conduct detailed analyses of employer claim files to identify population health risks, high-cost claims, and key drivers of overspending.
-Use population risk modeling tools to project healthcare costs, assess risk, and support the development of underwriting and quoting strategies for self-insured health plans.
-Support the development of underwriting and quoting for self-insured health plans, providing insights into cost projections and plan design options.
-Proficiency in data visualization and reporting tools to create clear, compelling, and interactive reports and dashboards.
-Ability to translate complex data findings into visually intuitive formats that facilitate strategic decision-making and communicate insights effectively to stakeholders, for example, in charts, graphs, and tables, to support analysis and reporting efforts.
What you need:
-5 yrs experience
-Experience in price transparency and/or group commercial claims analysis
-Experience working in PT or group claims / employee benefits claims
-Experience working in or adjacent to an engineering team
-Deep knowledge of SQL/ Python and querying complex datasets
-Experience using Python/DBT/Spark for data transformation
Benefits
For this position you must be currently authorized to work in the United States. We do not sponsor for this position.
Nitu Gulati-Pauly is recruiting for this position and the positions below.
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