Sr. Health Plan Operations Analyst
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
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.
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.
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.
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.
Dashboard Creation & Analytical Design
Auditing & Quality Assurance
Day-to-Day Operations
Leadership Support
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.