Job Description
Job Summary The Carrier Relations Analyst will play a key role in managing relationships with carrier partners and analyzing data to optimize carrier performance for a data analytics company. This role will involve leveraging data-driven insights to enhance the efficiency, cost-effectiveness, and reliability of carrier networks, ensuring smooth operations between the company and its partners. The ideal candidate will have strong analytical skills, a deep understanding of telecommunications and logistics operations, and excellent communication abilities to foster productive relationships with carrier partners.
This position is only eligible for legal residents of the United States of America. Key Responsibilities Carrier Management - Develop and maintain relationships with key carrier partners, acting as the main point of contact for day-to-day operations
- Collaborate with carriers to negotiate rates, resolve issues, and manage service level agreements (SLA's)
- Monitor and evaluate carrier performance against agreed KPI's, addressing any issues that may arise
Clinical Data - Identifying and investigating healthcare fraud, waste, abuse, and other forms of billing activities leading to improper payments. This work involves reviewing medical professionals, facilities, insured members, or the broker community in coordination with the customer’s carrier or third-party administrator
- Re view claims data and conduct analysis to look for patterns of potential FWA and other improper payments
- Utilizing information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels
- Conduct data analysis to review claim and case history
- Reviews claims history, medical reviews, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
Process Improvement - Identify opportunities for process optimization within the carrier management function
- Work closely with internal teams (Operations, IT, Finance, etc.) to implement improvements in the carrier management process
Qualifications Education & Experience - Preferred Bachelor’s in a degree in a health-related field
- 4 - 6 years of experience in carrier relations, or a data-driven role
Soft Skills - Strong interpersonal skills with the ability to manage relationships with external partners
- Excellent communication skills, both written and verbal, for report writing and presentations
- Strong analytical thinking with a problem-solving mindset and attention to detail
Key Competencies - Ability to analyze large sets of data to uncover insights and trends related to carrier performance
- Ability to manage multiple carrier accounts and related tasks simultaneously
- Ability to work cross-functionally with various internal teams (IT, finance, operations) to improve carrier-related processes
- Critical thinking, attention to detail
Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste, and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.
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