Claims Data Analyst

Position Overview

We are seeking a highly capable Claims Data Analyst to support our claims organization by generating, interpreting, and visualizing data from internal and third-party systems. This role also serves as the lead administrator for our legal billing system, manages Medicare reporting processes, and provides backup for a range of claims services functions involving data integrity and administrative duties.

In this role, you will have a high degree of responsibility for turning raw data into actionable insights, designing and automating reports and dashboards (primarily in Power BI), and driving data quality initiatives. You will work closely with stakeholders to understand business needs and translate them into impactful analyses and interactive visualizations.

Key Responsibilities

Data Preparation & Analysis

• Perform advanced data extraction, transformation, and load (ETL) processes from multiple sources (internal claims system, external vendors, etc.).
• Clean, structure, and merge large datasets to enable robust analysis and ensure data integrity.
• Utilize advanced Excel functions (PivotTables, advanced formulas, macros) and Power BI features (DAX, Power Query) to create repeatable, scalable reporting solutions.
• Experience with Azure Data Lakes (or comparable cloud data platforms) to efficiently store, manage, and retrieve large volumes of structured and unstructured data.

Data Visualization & Reporting

• Develop interactive dashboards and visualizations in Power BI that clearly communicate insights and trends to both technical and non-technical stakeholders.
• Select appropriate visualization techniques to highlight key performance indicators and business trends.
• Automate regular reports to streamline distribution to field adjusters, supervisors, and claims managers.

Data Interpretation & Insights

• Conduct deep-dive analyses to identify patterns, trends, and outliers within claims data.
• Present findings and recommendations to leadership, effectively telling the story behind the data to influence strategic decisions.
• Collaborate with the VP of Business Process & Analytics to shape the future of data-driven decision-making within the claims department.

System Administration & Process Ownership

• Serve as the lead administrator for a legal billing system and Medicare reporting process, ensuring timely submissions and compliance.
• Provide backup capability for claims services personnel by performing data integrity checks, claim closures, transfers, and other administrative functions in the internal claims system.
• Assist in optimizing system workflows, recommending enhancements based on data usage patterns and user needs.

Collaboration & Project Support

• Partner with cross-functional teams (IT, Finance, Operations) to enhance data consistency, build new data pipelines, and develop analytics solutions.
• Lead or participate in data-focused projects from concept to delivery, ensuring milestones are met, stakeholders are informed, and outcomes are clearly communicated.
• Offer guidance and mentorship to junior team members on data best practices, ensuring the overall analytics maturity of the department continues to grow.

Qualifications

• Bachelor’s degree in Business, Data Analytics, Computer Science, Statistics, or a related field.
• 3 years of relevant data analysis experience, ideally in an insurance, financial, or claims-related environment (1-2 years in the insurance industry strongly preferred).
• Expertise in Excel (PivotTables, advanced formulas, data manipulation) and Power BI (DAX, Power Query, M language).
• Proficiency in SQL for querying and manipulating data; knowledge of Python or R is a plus.
• Experience with Azure Data Lakes (or other cloud data platforms) to manage large data sets.
• Demonstrated ability to design compelling data visualizations, applying best practices to communicate insights effectively.
• Strong analytical and problem-solving skills with a track record of identifying trends and making data-driven recommendations.
• Excellent communication skills (verbal, written, and presentation) and a proven ability to collaborate across departments.
• High attention to detail, organizational skills, and the ability to manage multiple projects independently.