Claims Research Quality Analyst

Prospect Medical Holdings - Orange, CA

Full-time - Mid Level

Orange, CA

5,001-10,000 employees

Hospitals

About the position

The Claims Research Quality Analyst will play a crucial role in ensuring the accuracy and timeliness of various claims reports, including Daily, Weekly, Monthly, and Quarterly submissions. This position requires a detail-oriented individual who can analyze reports to identify deficiencies and recommend process improvements. The analyst will be responsible for the timely creation and submission of claims reports, ensuring that the database is refreshed daily to maintain the accuracy of the reports being distributed. In addition to report generation, the Claims Analyst will provide analytical support to the Claims Department by creating and analyzing ad hoc reports as needed. This role involves close collaboration with management to inform them of any discrepancies in the data generated. The analyst will also work closely with the IT department to communicate any system issues that may arise, developing appropriate recommendations and suggestions based on their analysis. The position requires the ability to independently create and develop high-quality analytical reports, dashboards, and other data visualizations with minimal guidance from management. The analyst must strategically plan and make logical, thoughtful decisions regarding projects, fully understanding the source files and tables used in the creation of meaningful reports via tools such as Excel, Power BI, and SQL. This role is essential for improving reporting efficiency and ensuring that the Claims Department operates smoothly and effectively.

Responsibilities

• Ensure that Daily, Weekly, Monthly, and Quarterly Claims Reports are submitted accurately and timely.
• Analyze reports to help identify deficiencies and recommend process improvements.
• Generate and distribute daily, weekly, and monthly reports in a timely manner.
• Refresh the database daily to ensure accuracy of reports being distributed.
• Provide analytical support to the Claims Department by creating and analyzing ad hoc reports as needed.
• Work closely with management to inform them of any discrepancies in the data generated.
• Collaborate with IT to communicate any system issues that might occur.
• Develop recommendations and suggestions based on analysis and collaborate with management in the development of action plans.
• Identify improvement opportunities to make reporting more efficient.
• Independently create and develop high-quality analytical reports, dashboards, and other data visualizations with little to no guidance from management.
• Strategically plan and make logical, thoughtful, independent decisions regarding projects.
• Understand the source files and tables used in the creation of meaningful reports via Excel, Power BI, and SQL.

Requirements

• Three plus (3+) years' experience as a medical claims adjuster or examiner, preferably in an IPA, MSO, or Medical Group setting.
• Experience handling provider issues.
• High School Diploma or GED required; Bachelor's degree preferred.