Claims Data Strategy Lead
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Job Location:
Monthly Salary:
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
Job Summary:
The Claims Data Strategy Lead roleis responsible forproviding seniorlevel handson leadership across complex healthcare claims data initiatives. This is a highly autonomous individual contributor role with full ownership accountability foridentifyingproblems driving solutions and delivering outcomes with minimal oversight.
The role requires rapid rampup strong technical judgment and the ability to translate complex and disparate claims data into scalable highperformance analytics that directly support product client and businessobjectives.
Key Responsibilities:
Own and drive endtoend solutions across healthcare claims data initiatives from problem definition through implementation and validation.
Serve as a senior authority on medical pharmacy behavioral health dental DME and ancillary claims data including experience with FACETs BlueChip Prime Therapeutics ESI and aggregated claims sources.
Design build andoptimizeadvanced SQLbased data models views and automation frameworks with a focus on performance scalability and maintainability.
Develop andmaintaincomplex claimadjustmentsequencing and disposition logic including support for split claims and multiple disparate source configurations.
Buildutilizationmetrics tied directly to underlying servicelevel data including inpatient outpatient professional and behavioral health levels of care.
Apply deepexpertisein healthcare transactions and standards includingHL7 and CCDA to ensure data accuracy and analytical integrity.
Independently assess unfamiliar data environments and rapidly develop a working understanding of new datasets using systematic repeatable methodologies.
Proactivelyidentifydata gaps risks and improvement opportunities and drive them to resolution without waiting for direction.
Partner closely with product analytics engineering and leadership teams to ensure claims data assets support broader business and client goals.
In addition to the responsibilities listed above this role is expected tooperatewith the following level of ownership and autonomy:
This role carries clear ownership accountability and is expected to proactively drive work forward rather thanoperatein a taskbytask or advisory capacity.
Given the seniority and scope of the role the individual isexpected tooperatewith a high degree of independence requiring minimal daytoday oversight.
Success in this role is defined by the ability toidentifyproblems propose solutions and execute through completion.
Qualifications:
Bachelors degree in Computer Science Information Systems or related field (or equivalent practical experience)
7-10years of experience working with healthcare data with deep specialization in claims data and analytics
Expertlevelproficiencyin SQL and advanced query development across large complex datasets
Extensive experience building andoptimizingcomplex data models views and automation frameworks within SQL platforms
Strong understanding of healthcare claims data structures including medical pharmacy behavioral health and ancillary claims
Demonstrated ability to develop andmaintaincomplex claim adjustment sequencing and disposition logic
Proven ability to independently assess unfamiliar data environments and rapidly develop working solutions
Strong analytical problemsolving and criticalthinking skills
Excellent communication and collaboration abilities across technical and nontechnical stakeholders
Ability to work independently take full ownership of initiatives and manage multiple priorities with minimal oversight
PreferredQualifications:
Experience working with FACETs BlueChip Prime Therapeutics ESI or aggregated healthcare claims sources
Handson experience with healthcare transactions and standards includingHL7 and CCDA
Experience developingutilizationmetrics tied to servicelevel claims data (inpatient outpatient professional behavioral health)
Strong understanding of performance tuning query optimization and scalability considerations in large data environments
Experience supporting analytics product or clientfacing use cases in healthcare or payment integrity contexts
Background in building reusable tabledrivenlogicand automation frameworks
Who isSmartLightAnalytics
SmartLightAnalytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mindSmartLightworks for self-funded employers to reduce the wasteful spend in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.
Required Experience:
Senior IC
Key Skills
- Marketing
- Data Visualization
- Tableau
- Customer Segmentation
- Microsoft Powerpoint
- Investment Banking
- Strategic Planning
- Financial Modeling
- Customer relationship management
- Management Consulting
- Google Suite
- Analytics
About Company
Harness the power of your healthcare data Solutions to lower healthcare costs without interrupting benefits Learn More DATA LEADS THE WAY SmartLight Analytics provides independent, ongoing monitoring of your employee healthcare claims data to find and remove wasteful spend from your h ... View more
