Senior Business Intelligence Engineer (Prospect)

Humana in Prospect, KY

  • Type: Full Time
position filled
Description The Senior Business Intelligence Engineer solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Senior Business Intelligence Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities This position will be responsible for creating insights and business strategy through utilizing both clinical knowledge and advanced data analysis skills. This will include data retrieval, validation, analysis and reporting, as well as researching TRICARE policy and competitive UM policies to create informed decisions for Utilization Management initiatives to support the TRICARE contract. Responsibilities include ensuring data integrity through validation of query design and data retrieval, leveraging data to make business recommendations to improve delivery of safe, effective care to beneficiaries, and creating dashboards to assist leaders in the day-to-day and long-term monitoring of Utilization Management programs. Position will require collaboration with Claims Oversight and IT to ensure alignment of UM and claims processes, and cost containment efforts, as well as identification and remediation of barriers. Key Accountabilities - Turn data into business strategy: Create actionable business strategies to support effective utilization management, focusing on positive impact to Trend and support of DHAs cost containment goals, while adhering to TRICARE benefit policy. This will be done through deep analysis of large amounts of clinical, claims, and utilization data, using both clinical and data acumen. Research TRICARE policy and competitive UM policies to marry with data insights to inform possible cost containment UM strategies. Query, prepare, validate, analyze and explain data from disparate sources in Enterprise Data Warehouse using SQL or Python, etc. Create and revise dashboards in Tableau or Power BI with business and healthcare data in order to drive business insights and visibility to early indicators. Collaborate with Claims Oversight and/or IT to ensure alignment of data elements, processes, communicate changes and ensure appropriate implementation. Required Qualifications Our Department of Defense contract requires U.S. Citizenship Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) Bachelor's degree in Nursing, Healthcare Management, Informatics, or related field 2+ years of experience querying and analyzing large sets of complex healthcare data Advanced proficiency in MS Excel, MS Access and Power BI or Tableau Advanced proficiency in writing complex SQL queries & joining disparate data Comprehensive knowledge of Microsoft Office Applications including Word, Excel, Access and PowerPoint Strong analytical and problem solving skills Deep knowledge of healthcare data, including medical claims, medical coding (CPT, ICD-10, DRG, etc.) and patient level data Experience in identifying and effectively communication actionable insights from data analysis Excellent written and verbal communication skills Ability to manage multiple priorities and work collaboratively across departments Preferred Qualifications Master's Degree in Nursing Informatics, Health Informatics, or equivalent RN license in current state of employment Experience in clinical research, URAC and/or medical policy Scheduled Weekly Hours 40

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