Healthcare Analyst III

Job Summary:

The Healthcare Analyst III is responsible for presenting analytical findings and recommendations regarding utilization to management and being proficient in identifying and quantifying opportunities to reduce medical costs within the market.

Essential Functions:

  • Present analytical findings and recommendations to management
  • Mentor new and developing Healthcare Analysts
  • Analyze healthcare utilization to identify patterns, variation, and outliers
  • Identify and quantify opportunities to reduce medical costs within the markets
  • Evaluate the effectiveness of medical cost reduction initiatives
  • Develop tools to efficiently compare market performance across and within products
  • Provide analysis and recommendations to inform network provider performance improvement
  • Monitor the efficiency and efficacy of clinical programs, interventions and processes
  • Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
  • Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
  • Segment population data to gain holistic intelligence via longitudinal trend analyses and advanced cluster analyses
  • Conduct root cause analyses of adverse population health outcomes based on demographic, socioeconomic and clinical factors
  • Perform any other job duties as requested

Education and Experience:

  • Bachelor’s Degree or equivalent years of relevant work experience is required
  • Advanced degree is preferred
  • Minimum of five (5) years of experience in healthcare analytics is required
  • Managed care experience is required

Competencies, Knowledge and Skills:

  • Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
  • Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required
  • Proficient in with Excel, Word and PowerPoint
  • Proficient with Transact-SQL or SAS or Microsoft Power BI or Tableau
  • Ability to organize data in a way that facilitates inferences, conclusions and decisions
  • Demonstrated written and verbal communication skills

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time