Healthcare Performance Analysis and Claim Management Manager (Quản lý Phân tÃch Hiệu suấ[...]

Prudential plc; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

Prudential is seeking a Healthcare Claims Analyst to oversee the analysis and reporting of healthcare claims performance. This role involves analyzing data to identify trends, advising on operational performance, and proposing data-driven solutions to enhance productivity and compliance within healthcare operations.

Responsibilities

• Monitor quality and clinical appropriateness of medical care.
• Advise on claims decisions and operational performance.
• Analyze data to identify trends and provide actionable insights.

Job description

Prudential's purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact on the business, and we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Role Overview

This role is responsible for overseeing the analysis and reporting of Healthcare claims performance. It involves analyzing data to identify trends, providing insights to enhance decision-making, and ensuring operations align with strategic goals. The role also includes proposing solutions based on data insights and advising business owners and the process management team on process improvement and knowledge management to prevent risk, fraud, and waste, thereby enhancing the productivity of healthcare operations.

Key Responsibilities

1. Work closely with the healthcare claims assessment and servicing team to monitor the quality and clinical appropriateness of medical care.
2. Advise on claims decisions and operational performance.
3. Ensure the daily availability and continuity of healthcare operation systems.
4. Adhere to operational metrics across the claims value chain.
5. Analyze data to identify trends and provide actionable insights.
6. Propose data-driven solutions and process improvements.
7. Support risk, fraud, and waste prevention efforts.
8. Maintain compliance with relevant regulations and standards.

Qualifications and Requirements

Details regarding specific qualifications, experience, and skills required for this role should be included here.

Additional Information

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.