aledade - Sr. Health Plan Operations Analyst
Requirements
• 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.
Responsibilities
• 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.
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