Provider Data Consultant

A company is looking for a Provider Data and Claims Consultant, Remote. Key Responsibilities Support behavioral health member and provider operations through pricing integrity audits and provider pick integrity programs Conduct market audits, analysis, reporting, and remediation as part of a workgroup Assess provider pick job aids and provide recommendations for rules engine development while acting as operational backup Required Qualifications 3+ years of data analysis and/or audit experience in the healthcare industry 3+ years of claims analysis and/or claims audit experience Advanced understanding of UHG provider data, including knowledge of NDB, OHBS Facets, or CSP Facets Experience leading cross-functional workgroups and defining detailed requirements for automation or user tools Intermediate proficiency with Microsoft Excel

May 22, 2025 - 14:50

A company is looking for a Provider Data and Claims Consultant, Remote. Key Responsibilities Support behavioral health member and provider operations through pricing integrity audits and provider pick integrity programs Conduct market audits, analysis, reporting, and remediation as part of a workgroup Assess provider pick job aids and provide recommendations for rules engine development while acting as operational backup Required Qualifications 3+ years of data analysis and/or audit experience in the healthcare industry 3+ years of claims analysis and/or claims audit experience Advanced understanding of UHG provider data, including knowledge of NDB, OHBS Facets, or CSP Facets Experience leading cross-functional workgroups and defining detailed requirements for automation or user tools Intermediate proficiency with Microsoft Excel