Sr. Health Plan Operations Analyst
About The Position
The Sr. Analyst, Health Plan Performance (HPP) Ops extracts, analyzes, and transforms complex health plan data into actionable strategic insights. The role drives dashboard creation, leads quality assurance auditing, and provides cross-functional leadership and mentorship to optimize value-based care contract performance. The position designs and maintains dashboards, productivity trackers, and KPIs; builds complex queries and visualizations; investigates data quality issues; audits year-end performance and claims data; and supports daily data operations using payer portals, claims files, SFTP sites, internal databases, Snowflake, Google Sheets, and Excel. The role also supports work coordination, mentoring, training, communication, and operational documentation.
Requirements
- Bachelor’s degree in a related quantitative field or equivalent professional experience.
- At least 4 years of experience with data management, analysis, quality assurance, and auditing healthcare or payer data.
- Intermediate SQL programming experience; Snowflake preferred.
- Advanced Microsoft Excel or Google Sheets skills, including complex formulas, nested functions, and pivot tables.
- Strong communication skills and ability to collaborate effectively across remote teams.
- Proactive mindset and proven ability to prioritize multiple tasks in a fast-paced environment.
Nice To Haves
- Understanding of value-based care or Alternative Payment Models, Medicare, and Non-MSSP quality measures.
- Experience with statistical software such as R or Stata.
Responsibilities
- Design, build, and maintain dashboards, productivity trackers, and KPIs for leadership to improve market performance and daily operations.
- Build high-complexity queries of back-end data for dashboards and custom ad-hoc projects.
- Present data findings through visualization tools so diverse stakeholders and colleagues can understand them.
- Incorporate industry benchmarks into visual metrics, including charts, graphs, and pivot tables, to show baseline and current states.
- Identify, monitor, and communicate changes or trends in quality and spend metrics.
- Investigate, triage, document, and resolve internal and external data quality issues as the first line of defense.
- Create and apply testing algorithms to evaluate large data streams throughout system data flow.
- Audit year-end performance and claims data for discrepancies and report errors to payer teams for resolution.
- Source, clean, and organize data from payer portals, Rx claims files, SFTP sites, and internal databases.
- Execute advanced SQL queries in Snowflake to supplement payer data for analysis and reporting quality assurance.
- Develop complex formulas and templates in Google Sheets and Excel to streamline repetitive data tasks.
- Maintain documentation on operational analytics, source-of-truth architectures, and peer cross-coverage plans.
- Assist the manager with work coordination, mentoring junior analysts, developing training plans, and reviewing team work products.
- Serve as a data subject matter expert and attend meetings in the manager's absence.
- Facilitate intradepartmental and cross-functional communication among key stakeholders.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
