Full job descriptionKPI Tracking and Reporting:Assist in the collection, organization, and analysis of utilization management KPIs for reporting to senior leadership and payers.Generate regular reports and dashboards in collaboration with the Data Analytics team.Utilization Analysis:Conduct analyses of concurrent and retrospective claims to identify primary utilization drivers by provider, physician, and service.Contribute insights into utilization trends and cost drivers using data visualization tools.Segment and Payer-Level Data Review:Perform data reviews on utilization patterns across business segments and payers to support targeted performance improvements.Provide input on payer-specific utilization trends to aid in developing remediation plans.Large Policy Support:Contribute to large policy utilization management by analyzing data on outlier claims and high-risk members.Assist in identifying potential interventions or consultations needed with payers.Education: Bachelor’s degree in healthcare management, statistics, or a related field.1. Data Analysis and InterpretationAnalytical Proficiency: Ability to analyze concurrent and retrospective claims data to identify utilization trends, drivers, and cost-saving opportunities.Data Interpretation: Skilled in drawing meaningful insights from complex data sets, understanding the implications of utilization patterns, and translating findings into actionable recommendations.2. KPI Monitoring and ReportingPerformance Metrics Management: Proficient in establishing, monitoring, and reporting on utilization management KPIs, ensuring that performance aligns with organizational and payer expectations.Regular Reporting: Ability to create clear and comprehensive reports for senior leadership and payers, showcasing trends, areas of concern, and improvements.

Performance Metrics Management: Proficient in establishing, monitoring, and reporting on utilization management KPIs, ensuring that performance aligns with organizational and payer expectations.Regular Reporting: Ability to create clear and comprehensive reports for senior leadership and payers, showcasing trends, areas of concern, and improvements.