JOB SUMMARY

Responsible for providing support to the division by providing data reporting needs. Independently performs reporting related tasks which are guided by policies, procedures, contracts and regulations requirements. Selects the best methodology to achieve the results identified in a plan of work or project. Responsible for collecting information based on facts, perform analyzes and makes recommendations that will be used by others in a higher hierarchical level. Collects statistical data internal and external with the purpose of providing information and recommendations to management for decision-making.

ESSENTIAL FUNCTIONS

• Develops new reports, dashboards and other means to enable transparency and to monitor network management operational processes and to provide timely information to senior management regarding status of compliance with guidelines, rules-regulations and internal policies and procedures and to assist with decision-making and tracking accountability.
• Identifies indicators and interprets statistical data to detect, correct and prevent situations that may negatively impact the department’s performance or compliance requirements.
• Determines the mechanisms for obtaining data on the use, clinical and demographic that is required internally and externally for analysis (programs, systems, etc.)
• Monitor and maintain the adequacy of the network, according to the contractual requirements.
• Coordinates plans and executes the reporting of data for the industry of health insurance, Blue Cross Blue Shield Association, Department of health, HEDIS and others.
• Ensure that Providers Directory is properly generated and available according to the corresponding Regulatory Agencies and to the policies and procedures established by the Network Management Division.
• Designs and implements quality improvement process including selection of valid and reliable indicators and coordinates monitoring and evaluation activities.
• Develops systems of accumulation of data and evaluation methods to be able to report any indicator that has to do with utilization and expenditure at different levels of the company.
• Compile and submit weekly,monthly,quarterly reports comparative statistical reports for internal and external data and identify trends, patterns, or fluctuations, and recommends future action for the Corporation.
• Communicates significant findings, including potential risk management issues.
• Participates and collaborates on internal and external audits, in the division’s processes automation, corporate and divisional projects, and other similar tasks.
• Collaborates with cross-functional team to ensure compliance and quality requirements are met per local and federal laws and regulations and other agencies as applicable.
• Responds to Ad hoc reporting requests by creating reports as needed for specific situations, such as other departments, auditors and external regulators.
• Monitoring performance through gathering relevant data and producing statistical reports. 

EDUCATION

EXPERIENCE

Bachelor’s Degree in Science or Business Administration, preferably with a major on Statistics, Mathematics, Finance or Computer Science with three (3) to five (5) years’ experience in related tasks and experience in Health Insurance Industry.  

LICENSES AND CERTIFICATIONS

COMPETENCIES