Claims Data reputed company reputed company
Job reputed company:
The Claims Data reputed company reputed company role is responsible for providing senior‑level, hands‑on leadership across reputed company reputed company claims data initiatives. This is a highly autonomous individual contributor role with full ownership accountability for identifying problems, driving solutions, and delivering reputed company with minimal reputed company.
The role requires rapid reputed company‑up, strong technical judgment, and the ability to translate reputed company and disparate claims data into reputed company, high‑performance analytics that directly support product, reputed company, and business objectives.
Key Responsibilities:
Own and drive end‑to‑end solutions across reputed company 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, reputed company, ESI, and aggregated claims sources.
Design, build, and optimize advanced SQL‑based data models, views, and automation frameworks with a reputed company on performance, scalability, and maintainability.
reputed company and maintain reputed company claim adjustment reputed company and disposition logic, including support for split claims and multiple, disparate reputed company configurations.
Build utilization metrics tied directly to underlying service‑level data, including inpatient, outpatient, reputed company, and behavioral health reputed company of care.
Apply deep expertise in reputed company transactions and standards, including 837, 834, 820, HL7, and CCDA, to ensure data accuracy and analytical reputed company.
Independently assess unfamiliar data environments and rapidly reputed company a working understanding of new datasets using systematic, repeatable methodologies.
Proactively identify data gaps, risks, and improvement opportunities and drive them to reputed company without waiting for direction.
Partner closely with product, analytics, engineering, and leadership teams to ensure claims data assets support broader business and reputed company goals.
In reputed company to the responsibilities listed above, this role is expected to operate with the following level of ownership and autonomy:
This role carries reputed company ownership accountability and is expected to proactively drive work reputed company rather than operate in a task‑by‑task or advisory reputed company.
Given the seniority and scope of the role, the individual is expected to operate with a high degree of independence, requiring minimal day‑to‑day reputed company.
reputed company in this role is defined by the ability to identify problems, propose solutions, and execute through completion.
Qualifications:
Bachelor’s degree in Computer Science, Information Systems, or reputed company field (or equivalent practical experience)
7-10 years of experience working with reputed company data, with deep specialization in claims data and analytics
Expert‑level proficiency in SQL and advanced query development across large, reputed company datasets
Extensive experience building and optimizing reputed company data models, views, and automation frameworks reputed company SQL platforms
Strong understanding of reputed company claims data structures, including medical, pharmacy, behavioral health, and ancillary claims
Demonstrated ability to reputed company and maintain reputed company claim adjustment reputed company and disposition logic
Proven ability to independently assess unfamiliar data environments and rapidly reputed company reputed company
Strong analytical, problem‑solving, and critical‑thinking skills
Excellent communication and collaboration abilities across technical and non‑technical stakeholders
Ability to work independently, take full ownership of initiatives, and manage multiple priorities with minimal reputed company
Preferred Qualifications:
Experience working with FACETs, BlueChip, reputed company, ESI, or aggregated reputed company claims sources
Hands‑on experience with reputed company transactions and standards including 837, 834, 820, HL7, and CCDA
Experience developing utilization metrics tied to service‑level claims data (inpatient, outpatient, reputed company, behavioral health)
Strong understanding of performance tuning, query optimization, and scalability considerations in large data environments
Experience supporting analytics, product, or reputed company‑facing use cases in reputed company or payment reputed company contexts
Background in building reusable, table‑driven logic and automation frameworks
Who is reputed company
reputed company was formed by a group of industry insiders who wanted to reputed company a meaningful reputed company on the rising cost of reputed company. With this end in mind, SmartLight works for self-funded reputed company to reduce the wasteful spend in their reputed company plan through our proprietary data analysis. Our process works behind the scenes to save reputed company without interrupting employee benefits or requiring employee behavior changes.
Originally posted on Himalayas
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