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Job Summary:
We are seeking a highly skilled and experienced Senior Director of Account Management and Analytics Advisor to work with large, self-insured employers, focusing on the delivery of high-quality healthcare data analytics solutions. The ideal candidate will have a strong background in healthcare analytics and a proven ability to translate complex, data-driven insights into actionable strategies and clear, digestible content for both analytical and non-analytical stakeholders. This role will involve leading client relationships, managing internal resources toward timely deliverables and ensuring the effective utilization of analytics to drive value and client satisfaction.
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Key Responsibilities:
Account Management:

• Act as the primary point of contact for self-insured employer clients, ensuring satisfaction and fostering long-term relationships
• Serve as a trusted advisor, understanding client needs and challenges, and offering strategic solutions to improve their healthcare programs
• Develop and maintain strong, strategic client relationships by understanding their business challenges and objectives, demonstrating exceptional problem-solving skills
• Coordinate and lead regular client check-ins, presentations and strategic reviews to ensure alignment and satisfaction
• Collaborate with internal teams (data, data science, clinical and investigative, executives etc.) to ensure optimal service delivery to clients
• Become fluent in healthcare claims data as relevant to company’s specific use case
• Nurture client relationships from infancy and throughout business relationship, including managing implementation process as needed
• Collaborate with new clients and their respective carrier(s)/data warehouse/PBM/other external constituents on all necessary documentation and other items in order to intake high-quality claims and health plan data

Data Analytics & Insights:

• Utilize advanced analytics tools and techniques to create insights that inform decision-making, cost-saving strategies and enhanced plan management
• Collaborate with internal teams to ensure the timely and successful delivery of data analytics solutions and insights
• Review client feedback and performance metrics to ensure solutions meet or exceed expectations
• Identify business enhancement opportunities that align with client needs and objectives
• Partner with the sales and solutions teams to develop strategic plans that address client goals
• Plan and lead client update presentations as well as ad hoc client meetings and written communications
• Assist the team in developing marketing initiatives, increasing business success and enhancing sales

Communication & Reporting:

• Translate complex data and analytical insights into clear, actionable reports and presentations for non-technical stakeholders
• Develop and deliver regular client-facing reports and presentations that highlight key performance metrics, trends and opportunities
• Explain technical concepts in a simple, understandable manner for benefits leaders, client executives and other decision-makers with limited technical expertise

Project Management:

• Coordinate internal resources and timelines to ensure smooth implementation and delivery of projects
• Troubleshoot client issues in a timely and proactive manner, ensuring client satisfaction
• Monitor key performance indicators (KPIs) to track the success of initiatives and client satisfaction
• Delegating tasks effectively and managing team dynamics

Team Collaboration:

• Work closely with cross-functional teams such as data scientists, project managers and consultants to deliver cohesive client solutions
• Contribute to team-wide best practices, sharing insights and strategies to enhance client success
• Develop and maintain strong executive relationships

Qualifications:

Education:

• Bachelor’s degree in business, marketing, economics, data analytics or a related field
• Master’s degree is preferred but not required

Experience:

• 5–8 years of experience in account management, client success or related roles within data analytics, technology, or consulting environments
• 4 years of experience in healthcare data analytics
• Proven experience managing senior-level client relationships and negotiating contracts or agreements

Skills and Competencies:

• Exceptional interpersonal and communication skills with the ability to understand and communicate technical insights to non-technical audiences in a tailored and thoughtful manner
• Ability to thrive in a fast-paced and lightly structured environment
• Hands-on, doer mindset
• Highly collaborative, team-focused, open communication and candid work style
• Strong problem-solving and strategic planning abilities
• Ability to break down complex problems into manageable components
• Identifying trends, patterns, and key insights in data
• Developing actionable recommendations based on data analysis
• Understanding data analytics concepts, tools and methodologies, with the ability to translate insights into client strategy
• Proven ability to lead and manage projects independently
• Experience in managing deliverables within deadlines

Preferred Knowledge:

• Strong existing relationships within jumbo self-insured plan sponsor community
• Procurement/medical ASA and/or PBM contract negotiation experience
• Familiarity with benefit analytics, data warehousing and claims data files
• Exposure to statistical methods, data modeling, or machine learning insights and how they inform business decisions
• Macro business knowledge of channels/industries relevant to the company’s client base (e.g. public sector, finance, healthcare, retail, technology, Taft-Hartley, etc.)

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Job Summary  
As a Clinical Analyst at SmartLight Analytics, you will play a critical role in analyzing and interpreting healthcare data to provide actionable insights for improving patient outcomes, optimizing clinical workflows and supporting healthcare decision-making. Our Clinical Analysts are dedicated to identifying, investigating, reporting on and eliminating healthcare fraud and other types of wasteful spend. This position is responsible for using medical coding knowledge, prior SIU/Payment Integrity experience and critical thinking to determine if a pattern of billing is suspect or if a claim is paid incorrectly. The company uses a customized web-portal tool to access claims data. The preferred candidate would be local to the Dallas, Texas area; however, this position is a hybrid position, and a qualified candidate can work remotely with periodic travel to the office. Timely quality deliverables are of paramount importance.

This is NOT a Data Analyst Position with SQL and data sets. 
This position is only eligible for legal residents of the United States of America.

Key Responsibilities

Clinical Data Analysis:

• Identifying and investigating healthcare fraud, waste, abuse and other forms of billing activities leading to improper payments. This work involves reviewing medical professionals, facilities, insured members or the broker community in coordination with the customer’s carrier or third-party administrator
• Review claims data and conduct analysis to look for patterns of potential FWA and other improper payments
• Utilizing information from claims data analysis, plan members and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels
• Conduct data analysis to review claim and case history
• Reviews claims history, medical reviews, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
• Ensure the quality, accuracy and integrity of clinical data by conducting data validation, cleaning, and preparation.

Collaboration and Stakeholder Engagement:

• Work closely with healthcare professional consultants, clinical teams and business analysts to understand the data needs of stake holders
• Collaborate with data scientists and engineers to build and refine analytics tools that enable improved decision-making
• Present findings and insights to internal teams, clients and stakeholders in a clear, understandable manner

Required Qualifications

• 3- 5 years’ work experience in healthcare billing, claims adjudication, fraud investigation, payment integrity operations and/or healthcare reimbursement
• 3-5 years’ experience with CPT and HCPCS code terminology
• Experience with data analysis as it relates to healthcare claims adjudication
• Strong critical thinking skills
• Experience with computer research
• Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
• Ability to be concise, independent and provide defensible decisions in writing
• Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
• Strong PC knowledge and skills, including all Microsoft Office products

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