Medical Claims Analyst

Job Summary

Utilize established financial systems and roll out enhanced analytics capabilities to track budgets and highlight variances in order to achieve financial effectiveness and operational efficiency.

Job Accountabilities - Key Accountabilities

• Ensure monthly reporting of Business Units to the data warehouse and constantly improve data quality and enhancing granularity and claims history as required to ensure effective performance management.Roll out enhanced reporting and analytics capabilities to the Business Units including embedding efforts to ensure effective usage of claims analytics applications.
• Identify deep dive areas in close collaboration with local Business Units. Provide an independent view of the issues and drive resolution, follow up and learning.
• Provide structured claims insight in close collaboration with other General Insurance functions at global, regional and local level to foster informed decision making.
• Drive the capability and up-skilling efforts in Business Units with adequate measures such as eLearning’s “General Insurance Claims – Managing by Numbers” to improve the effectiveness of performance management.
• Drive the further Business Unit based enhancement of Claims data and analytics in close collaboration with the local claims controlling teams including the sourcing of more granularity and up to 10 years of claims history.
• Contribute through requirements specification to the further enhancement of other claims data analytics systems.
• Foster the claims contribution in the Virtuous Circle discussion and foster the cross functional collaboration with Underwriting/Pricing, Reserving, Operations and Finance.
• Provide any sort of claims ad hoc analysis using sophisticated tools and technics.
• Drive the claims functional planning process for Zurich branches, ensure actionable insight, decisions and follow up.
• Drive the review process for branch, ensure actionable insight, decisions and follow up.
• Conduct sophisticated claims data mining and analytic investigations to spot underlying root causes on behalf of the Claims Analyst and Management.
• Provide detailed procedural advice to internal clients to ensure that internal standards are adhered to.
• Utilize established financial systems to track budgets and highlight variances in order to achieve financial effectiveness and operational efficiency.
• Act as a subject matter expert on the operational and financial claims performance process.
• Provide specialist advice to address specific queries from internal client area and deliver appropriate solutions.

Business Accountabilities

• Research primary data sources, select relevant information, analyze key themes and trends and make recommendations to inform policy and/or product development.
• Research, review and analyze claims handling protocol and/or customer proposition to support senior management in developing and improving processes and systems relevant to area of discipline.
• Provide specialist advice to address specific technical queries from internal clients and deliver appropriate solution, in line with the organization's policies and processes and regulatory requirements.

Job Qualifications

Required:

• A bachelor's degree in a relevant field.

Preferred:

• Extensive experience in medical claims processing and analysis
• Familiarity with insurance policies and industry regulations
• Strong analytical skills to review and assess complex medical claims for accuracy, compliance, and eligibility.