Healthcare Data & Claims Analyst II

HMSA; Honolulu (HI); On-site; USD 70,000 - 95,000; Full time

Job summary

HMSA in Hawaii is seeking a Research and Policy Analyst to support benefit and policy analysis, coding implementation, and post-implementation reviews. The role involves researching inquiries, analyzing data with SQL and MicroStrategy, and making independent recommendations to improve claims processing.

You will lead loading of new codes (CPT, HCPCS, ICD-10), support audits and documentation, and collaborate across departments to implement changes.

Qualifications

• Proficient at researching and responding to inquiries of low to medium complexity.
• Ability to extract and analyze data using SQL, MicroStrategy and other tools.

Responsibilities

• Research and respond to low to medium complexity internal and external inquiries.
• Extract and analyze data using SQL, MicroStrategy and/or other tools as available.
• Develop documentation including cost/benefit and business impact analysis and recommendations to implement and/or improve claims processing.
• Lead in loading of new codes by following existing documented processes (CPT, HCPC, ICD-10, etc.).
• Support audits and post-implementation reviews of policies and projects; identify cost increases and inequities.
• Participate in software implementation efforts and validation activities.
• Attend HMSA Continuing Education training classes as assigned.
• Perform other duties as assigned.

Skills

Data analysis

Independent decision making

Research skills

Tools

SQL

MicroStrategy

Job description

HMSA in Hawaii is seeking a Research and Policy Analyst to support benefit and policy analysis, coding implementation, and post-implementation reviews. The role involves researching inquiries, analyzing data with SQL and MicroStrategy, and making independent recommendations to improve claims processing.

You will lead loading of new codes (CPT, HCPCS, ICD-10), support audits and documentation, and collaborate across departments to implement changes.