Senior Manager Health Performance Management
Core
Monitor and track performance of Fraud, Waste and Abuse activities to support claim containment and provider network management.
Role type
Senior Manager, Health Performance Management (Analytics & Reporting)
Builds
Provider network scorecards, regulatory reports, and analytics materials for management support.
Domain
Health Insurance / Claims Management
Deliverable
dashboards & analysis
Required skills
Python, SQL, Excel, SAS, PowerBI, Data Science, Actuarial, Statistics, Machine Learning, Predictive Modelling
Preferred skills
None stated
Technologies
Healthhives, NCI assessor scorecard, Robotic procedure benchmark
Responsibilities
Monitor and track Fraud, Waste and Abuse activities; Support provider network management and discount rate improvement; Prepare data and scorecards; Submit regulatory reports (MHIT, LIFTO, HBM, Group FWA); Analyze claims data and appeals; Automate reporting processes.
Seniority
Senior, hands-on IC