Sr. Health Plan Operations Analyst
高级分析师，卫生计划绩效 (HPP) 运营负责提取，分析和将复杂的健康计划数据转化为可行的战略见解。这一角色推动仪表板创建，领导严格质量保证审计，并提供跨功能领导和指导来优化基于价值的护理合同性能。主要职责仪表板创造与分析设计 ·设计，构建和维护仪表板，生产力跟踪器和 KPI,以提高市场绩效和日常运作。·建立高复杂性查询后端数据供电仪表板和定制专业项目。· 通过可视化工具，清楚地呈现数据发现，以确保各方利益相关者和同事之间的理解。· 将行业基准纳入视觉指标 （图表，图形，转向表）来显示基本线和当前状态。·识别，监测和沟通质量和支出指标的变化或趋势。审计与质量保证 ·作为调查，分类，记录和解决内部和外部数据质量问题的第一条防御线。·创建并应用测试算法来评估整个系统数据流中的大型数据流。· 审计年度末绩效和索赔数据，以查找不一致情况，向付款团队报告错误以快速解决问题。日常运营 · 来源，清洁和组织来自多个流域的数据 （付款户端，Rx 索赔文件，SFTP 网站和内部数据库）. · 在 Snowflake 中执行先进的 SQL 查询来补充付款人数据进行分析和报道 QA. ·开发复杂的公式和模板在 Google Sheets 和 Excel 中简化重复数据任务。·维护有关操作分析，真相来源架构和同行跨覆盖计划的全面文档。领导支持 · 协助管理员协调工作，指导年轻分析师，制定培训计划和审查团队工作产品。·作为数据主题专家 （中小企业）;在经理不在场参加会议。·促进关键利益相关者之间的明确部门内部和跨职能沟通。其他任务如分配的最低资格 ·有关量学领域或同等专业经验的士学位。· 4年以上与数据管理，分析，质量检测和医疗保健或支付人数据进行审计的经验。· 中级 SQL.
查看英文原文
The Sr. Analyst, Health Plan Performance (HPP) Ops is responsible for extracting, analyzing, and transforming complex health plan data into actionable strategic insights. This role drives dashboard creation, leads rigorous quality assurance auditing, and provides cross-functional leadership and mentorship to optimize value-based care contract performance.
Primary Duties
Dashboard Creation & Analytical Design
- Design, build and maintain dashboards, productivity trackers, and KPIs utilized by leadership to improve market performance and daily operations.
- Build high-complexity queries of back-end data to power dashboards and custom ad-hoc projects.
- Present data findings clearly through visualization tools to ensure understanding among diverse stakeholders and colleagues.
- Incorporate industry benchmarks into visual metrics (charts, graphs, pivot tables) to show baseline and current states.
- Identify, monitor, and communicate changes or trends in quality and spend metrics.
Auditing & Quality Assurance
- Act as the first line of defense investigating, triaging, documenting, and resolving internal and external data quality issues.
- Create and apply testing algorithms to evaluate large data streams throughout the system data flow.
- Audit year-end performance and claims data for discrepancies, reporting errors to payer teams for swift resolution.
Day-to-Day Operations
- Source, clean, and organize data from multiple streams (payer portals, Rx claims files, SFTP sites, and internal databases).
- Execute advanced SQL queries in Snowflake to supplement payer data for analysis and reporting QA.
- Develop complex formulas and templates in Google Sheets and Excel to streamline repetitive data tasks.
- Maintain comprehensive documentation regarding operational analytics, source-of-truth architectures, and peer cross-coverage plans.
Leadership Support
- Assist the manager with work coordination, mentoring junior analysts, developing training plans, and reviewing team work products.
- Serve as a data subject matter expert (SME); attend meetings in the manager's absence.
- Facilitate clear intradepartmental and cross-functional communication among key stakeholders.
Other duties as assigned
Minimum Qualifications
- Bachelor’s degree in a related quantitative field or equivalent professional experience.
- 4+ years of experience with data management, analysis, QA, and auditing healthcare or payer data.
- Intermediate SQL programming experience (Snowflake preferred).
- Advanced Microsoft Excel / Google Sheets skills (complex formulas, nested functions, pivot tables).
- Strong communication skills with the ability to collaborate effectively across remote teams.
- Proactive mindset with a proven ability to prioritize multiple tasks in a fast-paced environment.
Preferred Qualifications
- Understanding of value-based care/Alternative Payment Models, Medicare, and Non-MSSP quality measures
- Experience with statistical software, such as R or Stata
Physical Requirements
- Prolonged periods of sitting at a desk and working on a computer.