Job Description

Responsible for analytical review of provider network performance for active, as well as, prospective Clients.  Develop and maintain a close working relationship with the internal departments for implementation and operation of new and current Client contracts

Essential Functions & Responsibilities

• This position requires strong analytical skills to thrive in a fast paced environment as well as be comfortable with management exposure.
• Analyze the claims utilization and cost performance of the specialty networks.
• Analyze the claims utilization data provided by prospective Clients.
• Review network accessibility (including quarterly geo-map analysis).
• Complete cost and quality metrics and report outcome to senior management and other departmental staff.
• Network oversight of adjudication of Claims by TPA.
• Maintain strong working relationships with Network Managers, acting as their key support in reviewing provider network performance.
• Provide tactical support and recommendations to network contracting team by assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance.
• Act as a liaison between Networks and TPA departments for assistance and operations of contractual obligations of Networks to its Clients.
• Work on various special projects and ad-hoc reports on an as needed basis.
• Develop and maintain familiarity with the managed care industry, such as availability of outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted providers.
• Attend all staff and committee meetings as requested by the Vice President of Network Operations and/or President  & COO, including evening quarterly Executive Committee Meeting.

Required Education and Experience

• Bachelor's degree or equivalent data analysis experience.
• Two or three years background in the managed care industry.