Consultant II Ideation & Analytics Data Mining

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

This role is to build and implement an effective data mining program. This position is responsible for data collection, data analytics and data reporting for Data Mining programs including but not limited to COB, Duplicate, Contractual, billing errors, overlapping services etc.

Job title:

Consultant II Ideation & Analytics Data Mining

Job Description:

Education:

• Bachelor’s Degree  

Experience:

• 5+ years’ experience in the health care payer industry (Medicare, Medicaid, and/or Commercial)

• 2+ years’ experience in Data Mining ideation and research of new concept development 

Mandatory Skills:

• Ability to think analytically, apply analytical techniques and to provide in-depth analysis

• Love collaborative environments that use agile methodologies to encourage creative design thinking and find innovative ways to develop with cutting edge technologies

• Proven interpersonal skills while contributing to team effort by accomplishing related results as needed

• Must be a team player and adaptable to a dynamic work environment

Preferred Skills:

• Proficiency in SQL/ PLSQL and MS Office products

Roles & Responsibilities:

Key Responsibilities:

• Identify new concepts which have the savings potential for development and deployment.

• Drive specific measurable results with timely deployment of concepts

• Work with audit leaders and establish a process to ensure the concepts being deployed are working as expected with higher findings thus ensuring higher hit rates and findings rates on the concepts deployed.

• Ensure to create review guidelines for concepts deployed to ensure operations and audit staff have all the information they need to work the concepts.

• Continually identify and deploy new edits and algorithms to drive incremental savings

• Establish strong relationships with internal and external stakeholders to define, align and delivery payment accuracy initiatives

• Influence leadership to adopt new ideas, and products as an experienced industry leader.

• Provide executive level program updates and manage team escalations

• Operate as an industry thought leader in Payment Integrity    

• Comply with HIPAA Compliance and Security Policies and Procedures

• Facilitate innovation and continuous process improvement

Location:

Work@Home USAUnited States of America