Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work.(sm) This position will be responsible for collecting, researching and analyzing data related to cost of care and utilization and publish management reports identifying trends and opportunities for cost management and reduction, including the identification of individual provider practice profiles. Primary Responsibilities: Conduct data mining and statistical analysis using the Dental Data Warehouse Construct predictive cost of care and utilization models Use statistical and analytical methods to identify utilization trends and dentist practice patterns and integrate clinical, third party, Facets claims and UR vendor data Investigate utilization problems and collect additional information to close gaps Create and publish periodic management reports at corporate, Line of Business, Group, Provider and Member levels as required Identify opportunities, through analysis, to manage and control cost of care Create and maintain databases as required to support analytics Identify providers with abusive claims patterns using analytic and statistical methods Create audit databases for investigating abusive providers Work cross-functionally and coordinate with others to gather information and overcome challenges in obtaining needed information
Required Qualifications: BS / BA in business or related field (4+ additional years of experience required in lieu of degree) 3+ years of experience extracting data in SQL / Oracle environment 3+ years of experience writing complex SQL queries without assistance 3+ years of experience working in the healthcare industry Advanced analytic skills using SAS, SQL and / or similar tools Strong Microsoft Excel, Word, and PowerPoint skills Experience working with data warehouses and databases Preferred Qualifications: 3+ years of healthcare experience in dental, insurance/claims processing Advanced expertise in statistics including regression modeling Ability to navigate Microsoft Access Databases and VBA Advanced degreeCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group 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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: clinical data analyst, clinical consultant, healthcare analytics, dental claims, telecommute, remote, work from home
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.