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
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Design, build and maintain dashboards, productivity trackers, and KPIs utilized by leadership to improve market performance and daily operations.
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Build high-complexity queries of back-end data to power dashboards and custom ad-hoc projects.
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Present data findings clearly through visualization tools to ensure understanding among diverse stakeholders and colleagues.
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Incorporate industry benchmarks into visual metrics (charts, graphs, pivot tables) to show baseline and current states.
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Identify, monitor, and communicate changes or trends in quality and spend metrics.
Auditing & Quality Assurance
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Act as the first line of defense investigating, triaging, documenting, and resolving internal and external data quality issues.
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Create and apply testing algorithms to evaluate large data streams throughout the system data flow.
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Audit year-end performance and claims data for discrepancies, reporting errors to payer teams for swift resolution.
Day-to-Day Operations
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Source, clean, and organize data from multiple streams (payer portals, Rx claims files, SFTP sites, and internal databases).
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Execute advanced SQL queries in Snowflake to supplement payer data for analysis and reporting QA.
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Develop complex formulas and templates in Google Sheets and Excel to streamline repetitive data tasks.