Healthcare Economics Data Analyst II

Clever Care Health Plan•Huntington Beach, CA

3d•$81,500 - $100,000•Hybrid

About The Position

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Requirements

Bachelor’s degree in Healthcare Administration, Finance, Economics, Actuarial Science, Statistics, Data Analytics, Public Health, Business, Information Systems, or a related field.
Three (3) to five (5) years of experience in healthcare analytics, healthcare economics, financial analytics, or managed care reporting.
Demonstrated experience with SQL, Excel, and Power BI or a comparable reporting tool.
Experience analyzing claims, membership, pharmacy, utilization, risk adjustment, quality, or population health data.
Intermediate to advanced SQL, Excel, data visualization, and relational-database skills.
Strong analytical and critical-thinking skills, including trend, variance, cohort, and financial-impact analysis.
Working knowledge of Medicare Advantage economics, claims, risk adjustment, Stars/Quality, population health, and value-based care concepts.
Ability to translate complex analyses into clear conclusions, limitations, and recommended actions.
Strong project management, documentation, stakeholder communication, and presentation skills.
Ability to work independently, prioritize competing assignments, and provide constructive peer review.
High attention to data integrity, confidentiality, and compliance.

Nice To Haves

Medicare Advantage or managed care experience strongly preferred.

Responsibilities

Independently design and complete moderately complex analyses of cost, utilization, unit cost, service mix, pharmacy spend, membership, risk scores, quality performance, and population health outcomes.
Own recurring dashboards, scorecards, worklists, and reporting packages from data extraction through validation, interpretation, and delivery.
Develop reusable SQL queries, data models, business rules, and automated reporting processes that improve timeliness and consistency.
Perform drill-down analyses by provider, medical group, product, region, risk type, member segment, diagnosis, procedure, and site of care.
Support risk adjustment financial analytics, including RAF trend, suspect and recapture opportunity, coding pattern, submission status, and intervention performance.
Support Stars/Quality analyses involving measure performance, care gaps, provider variation, intervention targeting, and outcome tracking.
Develop population health cohorts, risk stratification, chronic-condition prevalence, avoidable-utilization, outreach prioritization, and pre/post program evaluations.
Evaluate care management, pharmacy, quality, vendor, and culturally attuned benefit programs using utilization, engagement, outcome, satisfaction, and financial measures.
Investigate data anomalies, reconcile multiple sources, assess limitations, and recommend corrective action.
Present findings and recommendations to managers and cross-functional partners; contribute to executive-ready materials.
Gather requirements, define metrics, manage project timelines, and communicate risks or dependencies.
Provide peer review and technical guidance to Level I analysts.
Maintain compliance with HIPAA, CMS, corporate, and departmental requirements.
Perform other duties as assigned.