Sr. Health Plan Operations Analyst
Primary Duties
Dashboard Creation & Analytical Design
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Design, build and maintain dashboards, productivity trackers, and KPIs utilized by leadership to improve market performance and daily operations.
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Build high-complexity queries of back-end data to power dashboards and custom ad-hoc projects.
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Present data findings clearly through visualization tools to ensure understanding among diverse stakeholders and colleagues.
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Incorporate industry benchmarks into visual metrics (charts, graphs, pivot tables) to show baseline and current states.
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Identify, monitor, and communicate changes or trends in quality and spend metrics.
Auditing & Quality Assurance
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Act as the first line of defense investigating, triaging, documenting, and resolving internal and external data quality issues.
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Create and apply testing algorithms to evaluate large data streams throughout the system data flow.
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Audit year-end performance and claims data for discrepancies, reporting errors to payer teams for swift resolution.
Day-to-Day Operations
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Source, clean, and organize data from multiple streams (payer portals, Rx claims files, SFTP sites, and internal databases).
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Execute advanced SQL queries in Snowflake to supplement payer data for analysis and reporting QA.
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Develop complex formulas and templates in Google Sheets and Excel to streamline repetitive data tasks.
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Maintain comprehensive documentation regarding operational analytics, source-of-truth architectures, and peer cross-coverage plans.
Leadership Support
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Assist the manager with work coordination, mentoring junior analysts, developing training plans, and reviewing team work products.
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Serve as a data subject matter expert (SME); attend meetings in the manager's absence.
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Facilitate clear intradepartmental and cross-functional communication among key stakeholders.
Other duties as assigned
Minimum Qualifications
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Bachelor’s degree in a related quantitative field or equivalent professional experience.
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4+ years of experience with data management, analysis, QA, and auditing healthcare or payer data.
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Intermediate SQL programming experience (Snowflake preferred).
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Advanced Microsoft Excel / Google Sheets skills (complex formulas, nested functions, pivot tables).
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Strong communication skills with the ability to collaborate effectively across remote teams.
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Proactive mindset with a proven ability to prioritize multiple tasks in a fast-paced environment.
Preferred Qualifications
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Understanding of value-based care/Alternative Payment Models, Medicare, and Non-MSSP quality measures
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Experience with statistical software, such as R or Stata
Physical Requirements
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Prolonged periods of sitting at a desk and working on a computer.