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Analyst in Southfield, MI at AF Group

Date Posted: 6/24/2018

Job Snapshot

Job Description

COBX - Senior Health Services





SUMMARY:



The Analyst is responsible for reviewing pharmacy claims data, analyzing information, and remediating pharmacy claims issues. This role assists in researching and compiling appropriate and relevant data and feedback for risk activities and coordinating projects for management.



RESPONSIBILITIES/TASKS:




  • Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
  • Maintains comprehensive knowledge of business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
  • Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.
  • Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
  • Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
  • Assists in identifying resolution of challenges and issues in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
  • Assists in development of plans, reports, papers, and/or other material creation.
  • Provides assistance and feedback to corporate staff as required.
  • Assists with and documents feedback between corporate business areas and participates in group or committee discussions.

    This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.





    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in Business Administration, Health Care Administration, or a related field preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.



    EXPERIENCE:



    Minimum two years of pharmacy technician experience is required.

    Previous analytical experience preferred

    Pharmacy claims or inquiry processing experience preferred.

    Knowledge of Medicare guidance and audit experience is preferred.



    SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:



    Critical thinking and analytical skills; ability to take loosely formed ideas, coordinate multiple, and evolve them.


  • Ability to work in a time sensitive, rapid pace environment with shifting priorities and high exposure to different levels of management
  • Highly organized and structured.
  • Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques
  • Strong writing and communication skills.
  • Microsoft suite with an emphasis on PPT, Excel, Word and Project.



    WORKING CONDITIONS:



    Work is performed in an office setting with no unusual hazards.

    The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

    We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
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