Manager, Claims Modernization, Reporting & Analytics

Description and Requirements

The Manager, Claims Modernization Reporting and Analytics is responsible for the successful implementation of strategic initiatives as a part of a large team of Business, Data and Project Analysts. This individual will be responsible for partnering with their team in support of process improvement initiatives, development of a reporting and analytics program, as well as in-area and corporate projects. This position will have responsibility for collaborating with executives and stakeholders on defining and developing consumable reporting for use in driving insightful business decisions. This individual will take initiative in improving our overall data quality, testing methodology, creating reporting and visualization that meets the needs of our stakeholders. This position will manage competing objectives and prioritizes accordingly. The Manager will take lead on projects aimed at improving performance and efficiency by leveraging their skills to accomplish tasks and achieve departmental and corporate strategic goals.

• Deliver data-driven analytics solutions and visualizations provide meaningful, accurate, and consumable information to department leaders.
• Define and implement metrics, quality benchmarks and related analysis on performance and service levels to inform strategic and tactical business decision-making.
• Analyze and interpret complex data sets to determine root cause(s) to business performance issues
• Recommend business controls to improve business results
• Partner with supervisor and peers to establish goals, priorities and deliverables of Business/ Project Analyst team. Ensure long-term strategic and short-term tactical Operational needs for process improvement, reporting, and project support are agreed upon and accomplished.
• Manage progress and deliverables on all initiatives, consistently seeking more efficient ways to support the business using technology, cross-training, and other tools to ensure their own optimal performance as well as performance of the Business/Project Analyst team.
• Regularly meet with supervisor, peers, and stakeholders to drive high performance results.
• Collaborate across impacted stakeholders to translate business needs into technology solutions, implement reporting tools that maximize efficiency, and foster a high-performance culture.
• Gather business requirements, develop business rules, and implement process controls and reporting.
• Prioritize, and monitor workload to ensure continuous progress in being made.
• Remain current on reporting and database technologies and ensure Healthfirst is leveraging existing systems to maximize optimal value.
• Collaborate with Information Technology, Business Transformation and Operations teams to support effective department management including introducing new technology, system upgrades and reporting impacts and providing leadership dashboards to assist with managing our business.
• Articulate conclusions and opinions in a persuasive and influential manner, with well-developed data-driven analyses or solutions that establish trust.
• Partner on development and implementation of a strategic multiyear project and resources plan and participate in setting and executing operational plans consistent with organizational strategy.
• Support a variety of ad-hoc report requests.
• Attend and conduct team/project meetings as needed
• Additional projects and duties as assigned.

• Experience exhibiting strong critical thinking, problem solving, and analytical skills.
• Experience within any area of operations (Member Services, Enrollment & Billing, Claims, Provider Services, etc.).
• Experience with database reporting and automation, budgeting or internal audit processes.
• Experience monitoring quality in a reporting and analysis environment.
• Experience conducting root-cause analysis and making recommendations based on your findings.
• Experience with Tableau, Alteryx, or similar data visualization and data wrangling tools.
• Familiarity with relational database structures, theories, principles, and practices.
• Familiarity with data models and/or data modelling.
• Experience with Microsoft Excel including the use of formulas, Pivot tables, and graphs to manipulate and analyze data.
• Bachelor's degree from an accredited institution or equivalent work experience.

• Experience working within a Healthcare industry (such as commercial insurance plans, hospital, managed long-term care or government programs).
• Familiarity with healthcare data.
• Experience working with MS Office Suite, including MS Access (reporting), MS PowerPoint (creating/editing presentations), and MS Visio (creating flow charts) and Adobe Acrobat (converting PDF files).
• Ability to gather requirements, design, test and implement using agile methodologies.
• Advanced communication skills with the ability to present to a diverse audience, including Senior Management.
• Problem solving skills; ability to think strategically and critically in developing solutions to complex problems.
• Strong quantitative and analytical skills.