Healthcare Data and Recovery Manager
Bupa
Hong Kong
10天前

Job Purpose

Your role will be critical to deliver the processes, environment(s) and software tools used to enable the analysis of this information for purposes of strategy development and key decision-

making associated with claims leakage and funding structure(s) solutions.

You will be responsible for ensuring clinical and business data integrity and the provision of accurate and comprehensive legislatively mandated clinical data.

Accountabilities and Activities :

  • Data Integrity - ensure that quality data (claims, provider, member, product, clinical) is available expeditiously in a structure and format that provides maximum analytical flexibility and meets industry standards
  • Standardise data to allow for meaningful comparative analysis e.g. age / sex / severity standardisation
  • Maintain, develop and customise analytical applications both third party and in-house so that all HRM staff can self-serve with standard reports
  • Advanced Clinical Analysis : Take the analytical lead in identifying, investigating and explaining trends in service utilisation, mix, price and product with recommendations regarding product changes, benefit limits, and business and clinical rules
  • Perform advanced statistical analytics tasks, including but not limited to :
  • Data Mining
  • Segmentation and profiling
  • Discriminant Analysis
  • Time series forecasting
  • Sampling Techniques to identify targets of Audits
  • Create meaningful analytical outputs
  • Ad-hoc and Customised data analysis
  • Use techniques from business intelligence, statistical analysis and modelling to deliver business insights :
  • Ensure that inappropriate benefit payments are kept to a minimum through the provision of insightful analysis to the claims analysts
  • Analysis of referral patterns
  • Supply / demand analysis
  • Forecasting based on population growth, epidemiological ratios, and company / group commercial strategies
  • Segmentation of targeted provider, member and staff.
  • Completing relevant provider analysis of service utilisation and benefit scenarios :
  • Ensure that inappropriate benefit payments are kept to a minimum through the provision of insightful analysis to the claims analysts
  • Analysis of referral patterns
  • Supply / demand analysis
  • Forecasting based on population growth, epidemiological ratios, and company / group commercial strategies
  • Future proofing : Ensure through constant external and internal scanning that the tools, structures and techniques available to Bupa ensure Bupa continue to offer best practice resources (people / process / technologies) associated with healthcare analytics
  • Work in accordance with Bupa Australia’s Health and Safety policy, always applying safe working practices and procedures and comply with all instructions given about ensuring health and safety at work.
  • To be considered for the role, you should ideally have :

  • At least five years experience with advanced statistical methods generally, and particularly in the areas of predictive modelling and business analytics
  • Ideally five years experience in a private or public sector clinical setting, or equivalent experience in insurance and finance
  • A Tertiary qualification in Statistics, Mathematics or Econometrics or relevant disciplines. Master’s degree or PhD an advantage.
  • Detailed & sophisticated understanding of clinical services
  • Demonstrated experience in data modelling and data interpretation
  • Hands-on experience with Statistical Packages and Language, Databases and SQL. Conducting statistical analysis (e.g., hypothesis testing, regression, etc) using statistical software (SAS, SPSS, R, etc), in a health or commercial setting is desirable.
  • Clear and effective verbal and written communication.
  • Ability to manage time and consistently meet tight deadlines.
  • Ability to work in a rapidly changing and interrupt-driven environment.
  • Knowledge of health care, claims, or marketing data is desirable.
  • Bupa offers 5 days work per week and comprehensive remuneration packages including base salary, performance bonus, study assistance plan, non-

    contributory pension plan, life and medical benefit, dental benefit, annual leave, examination leave, etc.

    Personal data collected will be used for recruitment purposes only. Only candidates selected for interviews will be contacted.

    Bupa will be in touch for any opportunities that matches your profile. All personal data of unsuccessful application will be destroyed 24 months from the date of receiving the application.

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