Claims Analyst

Experience building a database from a market research perspective and/or from an interpretation perspective.  These individuals will be building out core databases for in patient/out patient data, hospital charge data, and claims data  They need to have at least a Bachelor’s Degree.  Medical device experience in Outcomes would be a plus.  Must have excellent communication skills.  Responsibilities include:
1) Perform Claims Analysis –  on a procedure level, and line level – using preferred hospitals and ASC components of the claims – the consultant really needs to understand what is on those claims and be able to manipulate the lines.
2) Build out initiative – using value added information sets/datasets
3) Item level utilization – produce a model on how this would impact the client’s spend. 
Key words to look for on resumes (these were buzz words on the 2 resumesof the candidates selected for an interview that the manager pointed out to us today):
 
analyzing claims
analyst, health informatics

Medical cost management initiatives/analysis, and business models
medical policy criteria
site of service management
SQL
build and manipulate databases
marketing, product development or sales support background are a plus
 
The manager said that they do not need to have SQL experience (that is a plus)but, knowledge of some operating system where they have experience building and manipulating that database.  They can have experience with Oracle, Access, etc.