Health Economics & Provider Analytics

Job Description

To execute and complete specific deliverables and activities to analyse and validate statistical data using advanced analysis to identify and quantify impacts on medical cost trends with the objective of providing the highest appropriate quality and cost-effective care for its members

Healthcare Dala Analysis:

• Design data models that integrate patient data from multiple sources to create complete views of health data

• Members health risk segmentation and chronic cases profiling (e.g., chronic disease, cancer, hepatic disease, renal failure) to be of value in cost savings and, customer retention.

• Conduct feasibility and impact studies for the planned projects

• Publish monthly reports for top providers for all data about, high value drivers, high value medications, and high value cases.

Business opportunities:

• Develop quantified business waste for outlier behavior or billing irregularities

• Identify and eliminate inefficiencies to create a portfolio of work leading to savings.

• Share savings opportunities from recoveries or prevention and monitor provider inflation according to medical conditions and benefits

• Validate savings before and after the executed actions by measuring the realized impact of the cost management activities

Data Management:

• Apply advanced categorization of services with standardized and concise mapping.

• Manage Initiation and maintenance of new enhancement segmentation for services and medical conditions

• Ensure proper validation of doctor names in the data, specialties, modifying and validating of the unified service coding process

Providers Commercial Terms:

• Develop and review terms with providers within Bupa’s network as well as prospective providers to introducing them into the network.

• Create and implement new templates for price comparison and its impact studies, considering all the variations in the providers’ billing, and the services complexity.

Analysis Transformation:

• Collaborate with the different business units and functions in order to execute the assigned objectives related to Big data projects and digital enhancements, transformations and implementations

• Interpret and validate data to be incorporated into advanced analytics and ML models.

Provider’s Inflation Monitoring:

• Monitor medical inflation figures with ongoing effective oversight of all potential hits that may affect cost on short term and long term perspectives.

• Provide information about various costs trends, initiatives being taken in operations and monitor the progress against each initiative and exceptions that require actions.

Skills

• 3 - 5 years experience preferrably in healthcare/ health insurance

• Bachelor degree preferrably with medical background

• Intermediate to advanced skill level with MS Excel and PowerPoint

• Data analysis including healthcare claims data manipulation

• Ability to interpret both high level and detailed view of the data