Utilization Management Analyst - Insurance TPA

1. JOB PURPOSE

The Utilization Management Analyst is responsible for supporting the utilization management team through the analysis and reporting of KPIs, identifying key utilization drivers, and contributing to large policy management initiatives. This role requires a data-driven approach to analyze claims, track performance metrics, and collaborate on the development of insights that promote effective utilization of healthcare resources.

2. RESPONSIBILITIES AND DUTIES

KPI Tracking and Reporting:

Assist in the collection, organization, and analysis of utilization management KPIs for reporting to senior leadership and payers.

Generate regular reports and dashboards in collaboration with the Data Analytics team.

Utilization Analysis:

Conduct analyses of concurrent and retrospective claims to identify primary utilization drivers by provider, physician, and service.

Contribute insights into utilization trends and cost drivers using data visualization tools.

Segment and Payer-Level Data Review:

Perform data reviews on utilization patterns across business segments and payers to support targeted performance improvements.

Provide input on payer-specific utilization trends to aid in developing remediation plans.

Large Policy Support:

Contribute to large policy utilization management by analyzing data on outlier claims and high-risk members.

Assist in identifying potential interventions or consultations needed with payers.

Job Types: Full-time, Permanent

Pay: AED9,000.00 - AED12,000.00 per month

Work Location: In person