What are the responsibilities and job description for the Claims Data Analyst position at SEIU?
Job Type
Full-time
Description
POSITION TYPE : Hourly, Non-Exempt
BARGAINING UNIT : Bargaining Unit
WORK ENVIRONMENT : Hybrid
SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with delivery of health and pension benefits. Our employees epitomize the Fund's core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.
Position Summary :
The Claims Data Analyst is responsible for performing highly complex health care related data analysis. The work of the Claims Data Analyst involves analyzing health care related data to support benefit plan design, contract monitoring, participant utilization and other health care related data to identify trends and anomalies for decision-making by the Department and Fund Office leadership. This role will report to the Claims Supervisor and collaborate with leadership across the organization to provide data, analysis, and recommendations. This role is also responsible for learning and understanding the complexities of the organization's database and the functions of the various the departments to make sense of the data in review.
The Claims Data Analyst also supports the Claims Department in enhancing solutions to improving health access and health outcomes of the plans' participants by analyzing data to inform business decisions and finding technological solutions for claims tracking needs.
The Claims Data Analyst will be responsible for the following :
Key Duties and Responsibilities :
- Lead the review of and reporting on health care claims, pharmacy data, participant service utilization, and pricing to assist with management decisions.
- Lead ad hoc analysis of population engagement trends, behavioral trends, health needs and patterns, high-cost claims, and costs by geographic area and place of service to facilitate utilization management decisions.
- May assist in analyzing the impact of new and proposed changes to group health benefit programs and plan design and make recommendations to Claims Department leadership based on analyzed data.
- Assist in the development of a tracking tool for claims productivity reports.
- Collaborate with Claims Department leadership to determine other department reporting needs.
- Provide feedback and recommendations to the Claims Supervisor based on analyzed data.
- Create and / or maintain repricing calculators in Microsoft Excel.
- Develop and distribute various department reports and data analysis.
- Create relevant documentation, including but not limited to, user stories / use cases, screen mockups, process flow documents, and data flow diagrams.
- Develop, define, and build technology business cases that will enable business and technology change.
- Research, analyze, and evaluate current departmental practices, policies, procedures, guidelines, processes, systems, and forms; and assists in developing and implementing improvements and enhancements. Collaborate with the claims team to formulate functional requirements and specifications.
- Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements.
- Create one-on-one (1 : 1) agendas using the Purpose, Outcome and Process (POP) Model and thorough notes must be kept for each meeting.
Privacy and Security Responsibilities :
This position requires the handling of Personal Identifiable Information (PII) and Protected Health Information (PHI) of our plan participants. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officers.
Requirements
Education Requirements :
Minimum Qualifications :
Job Requirements :
Preferred Experience :
Career Development & Continuing Education Opportunities : Yes
Benefits :
SEIU Healthcare IL Benefit Funds offers competitive compensation and a comprehensive benefits package which includes health coverage (medical, dental and vision) for employees and eligible dependents, including no employee premium option for employee only; generous time off; and a defined benefit pension plan.
Diversity & Inclusion creates a healthier atmosphere : SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.
Additional benefit info may be found here : 2025 Pay and Benefits IL.pdf
Salary Description
26 - $33 / hour
Salary : $26 - $33
