4536089-Manager

Claims Data Mining/Programmer – JD Job Description: Ø Collect, clean and process large volumes of claims data using advance data mining tools. Ø Perform data mining and identify trends, patterns and correlations within the claims data. Ø Identify discrepancies and inconsistencies in claim payments by analyzing data in comparison to the historical claims data. Ø Design and implement automated data extraction and reporting processes. Ø Develop Python/VBA macros and applications to automate reporting. Ø Reporting and presenting findings in a clear and actionable manner. Skills/Experience: Ø Good experience with data mining and data analysis. Ø Proficiency in data analysis tools such as Python, SQL, VBA. Ø Knowledge of health insurance and claim processes is highly preferred. Ø Strong analytical and problem-solving skills with keen attention to detail. Ø Should understand VBA object model for Excel and Access very well. Ø Experience in designing user form-based applications in MS Access and MS Excel. Ø Should have good logical skills and should be able to translate a manual process flow to a Python/VBA code. Ø Identifying overpayment opportunities by: Reviewing claims processing policies and guidelines. Reviewing provider contracts. Analyzing historical overpayment trends. Analyzing claims data to identify outliers. Ø Contribute toward team’s yearly target of overpayment identification. Ø Review and validate claims. Ø Assist team members and as and when required. Ø Maintain and track overpayment projects in an organized and timely manner. Ø Adhere to all client and company policies without exceptions. Candidate Profile: Education/Qualification: Any graduate/post-graduate Work Experience: 2 years+ as Python, SQL and VBA Programmer. Functional Skills: Python, SQL, VBA, MS Access and MS Excel. Behavioral/ Leadership Skills: Good English communication, very good logical skills, should be able perform as an individual contributor without much supervision. Should be able to understand and follow instructions, ask questions and make suggestions for processing improvement when required.