Senior Statistician - CGS Administrators
Nashville, TN  / Columbia, SC 
Posted 4 days ago
Job Description
Internal Reference Number: R1021933 Summary Utilize innovative and effective data mining techniques to search and analyze data for useful patterns and/or relationships used to identify aberrant supplier billing behavior. Provide guidance in designing new metrics for reporting. Standardize and implement process improvements for reporting across lines of business (LOBs). Contribute to reduction of necessary risk management. Conduct applied research on business processes. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings.Description

*35% Analyze claims data and perform statistical calculations using approaches such as longitudinal analysis, mixed effect modeling, logistic regression analyses, and model building techniques. Create and validate statistical samples of overpayment estimation, which includes calculating sample size and determining sample selection methodology. Design new metrics and draw conclusions or make predictions based on the statistical analyses.

*25% Communicate results or predictions to management and peers. Prepare statistical data for inclusion in reports to data monitoring committees, federal regulatory agencies, management, or clients. Analyze information and evaluate results to choose the best solution in solving problems. Develop, design or create new ideas, reports, and analyses to solve problems.

*20% Create requirements documents for report development. Respond to data requests. Design reports and suggest new methods of data analysis through data mining, exploration, and statistical methodologies. Streamline or automate statistical reports for scaling and replication. Document processes and standards for replication of the final process.

*10% Organize, lead, and initiate meetings and tasks related to coordinating data analysis efforts and problem solving. Determine project plans, timelines, or technical objectives for statistical aspects of projects. Provide guidance and direction to statistical programming staff in the design and development of complex data management tools.

*5% Review the Provider Integrity Manual and implement technical standards, guidelines, policies, and formal regulations that meet all appropriate requirements.

*5% Communicate scientific or technical information to the public, organizations, CMS, or internal audiences through oral briefings, written documents, conferences, or training sessions. Attend conferences and converse with colleagues to keep abreast of methodological or conceptual developments in statistics and Medicare claims review.

Required Work Experience:

  • 6 years statistical interpretation.
  • Relational database experience. (may be concurrent)

Required Education:

  • Bachelor's or Master's degree Statistics/Biostatistics, Mathematics, or other job related field.

Required Skills and Abilities:

  • Ability to use complex mathematical calculations.
  • Demonstrated knowledge of mathematical or statistical concepts.
  • Excellent presentation skills.
  • Strong oral and written communication skills.
  • Strong organizational and analytical skills.
  • Relevant computer programming skills.

Software and Other Tools:
  • Advanced knowledge of Microsoft Office.
  • Knowledge of a statistical software program such as SAS Enterprise Guide or SPSS

Preferred Licenses and Certificates :
  • Membership in the American Statistical Society (ASA) or National Healthcare Anti-Fraud Association (NCAA).

Work Environment:
  • Typical office environment. Some out of town travel may be required.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.


Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
6+ years
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