Sr. Health Plan Operations Analyst

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 

• 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.

• Understanding of value-based care/Alternative Payment Models, Medicare, and Non-MSSP quality measures

• Experience with statistical software, such as R or Stata

• Prolonged periods of sitting at a desk and working on a computer.