Health Care Analyst III
About The Position
The Healthcare Analyst III develops, documents, and programs in support of 5-Star projects and in-house initiatives. The role conducts in-depth data analysis and interpretation, HEDIS reporting, and related work to support high 5-Star ratings. The analyst works with Medicare Advantage and healthcare datasets, including membership, provider, claims, authorizations, pharmacy, and financial information. The position conducts data management, quality improvement studies, statistical analysis, and reporting; interprets organizational data; investigates root causes and trends; and develops actionable recommendations. It also leads QA processes for reported data, manages multiple projects, troubleshoots data anomalies with stakeholders, and presents findings to Analysts and management. The analyst provides guidance and training to lower-level Analysts and serves as a contact for internal and external customers. SCAN seeks someone curious about AI and its potential to transform operations and member service.
Requirements
- Bachelor’s degree or above in Math, Statistics, Biostatistics, Computer Science, or another quantitative discipline.
- At least 5 years of analytical experience, or at least 4 years of analytical experience in a healthcare or managed care environment.
- Advanced-level proficiency with the MS Office Suite.
- Proficiency with MS SQL queries.
- Excellent technical, interpersonal, written, and oral communication skills.
Nice To Haves
- Experience with HEDIS.
- Experience with medical claims or encounters data.
- Snowflake experience.
- SQL Server Reporting Services and SQL Server Integration Services experience.
- SAS (Statistical Analysis System) experience.
- Power BI tool experience.
Responsibilities
- Research and conduct moderate analysis of Medicare Advantage and healthcare data, including membership, provider, claims, authorizations, pharmacy, and financial information.
- Design and produce timely analyses and interpretations of large healthcare datasets related to 5-Star ratings, HEDIS, state-specific programs, state agency programs, and other company initiatives.
- Lead the development, implementation, and documentation of quality assurance processes to ensure reported data is accurate and reliable.
- Conduct data management, quality improvement studies, statistical analysis, and report generation; present findings to higher-level Analysts and HCI mid- and senior-level management.
- Perform moderate to complex data analysis, including data mining, verification, mapping, scrubbing, and scraping.
- Develop actionable and supportable findings within tight deadlines and changing requirements.
- Investigate root causes, interpret results, identify trends, and recommend actions.
- Work with internal and external stakeholders to troubleshoot and correct data anomalies.
- Manage multiple moderate to complex projects concurrently, prioritize work, meet timelines, and communicate workload issues to management.
- Train, guide, and support lower-level Analysts.
- Serve as a point of contact for internal and external customers, resolve routine and complex questions and problems, and escalate the most complex issues as needed.
- Proactively monitor and clarify technical responses to business requirements on Medicare-related projects to ensure business needs are understood.
- Support the achievement of SCAN’s vision and goals.
- Perform other duties as assigned.
Benefits
- Annual employee bonus program.
- Robust wellness program.
- Generous paid time off (PTO).
- 11 paid holidays per year, one floating holiday, and one birthday holiday.
- 401(k) retirement savings plan with employer match.
- Employee recognition program.
- Tuition reimbursement.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
