Strong understanding of clinical workflows and healthcare economics.
Ability to translate complex analytics into clear insights for executives.
Experience developing effective presentation materials for stakeholders.
Exceptional verbal and written communication skills.
Responsibilities
Lead analytics initiatives for total cost of care in specialty services.
Identify and analyze drivers of specialty spending in various fields like vision and dermatology.
Monitor PMPM trend performance across specialties and lines of business.
Evaluate utilization patterns and recommend cost-saving opportunities.
Design analytics frameworks for measuring provider efficiency and quality.
Analyze claims experience to derive insights on profitability across products and markets.
Support underwriting and growth teams with data-driven insights for client proposals.
Optimize site-of-care and reduce network leakage through data analysis.
Lead collaboration with IT and data engineering to enhance data accessibility.
Mentor junior analysts to build overall analytics capabilities.
Drive automation of reporting workflows and implement scalable solutions.
Benefits
Collaborative work environment that fosters mentorship and growth.
Opportunities to work with advanced analytics and AI integration.
Engagement in cross-functional projects with diverse teams.
Focus on performance-driven outcomes in healthcare analytics.
Possibility of influencing strategic decision-making at the executive level.
Full Job Description
Key Responsibilities
Lead analytics initiatives supporting total cost of care performance across specialty services
Identify drivers of specialty spend across specialties such as vision, dermatology, therapy etc.,
Monitor PMPM trend performance across specialties and all lines of business.
Evaluate utilization patterns and recommend cost-reduction opportunities
Design analytics frameworks measuring provider efficiency, access, and quality performance
Evaluate book-of-business claims experience to develop insights on profitability and competitive positioning across products and markets
Support underwriting and growth teams with data analysis and insights for new client proposals and value propositions
Analyze site-of-care optimization opportunities, network leakage and utilization across provider networks
Support contract performance evaluation and savings analysis
Partner with finance, clinical and operational leadership to define and develop KPIs aligned with enterprise performance goals.
Present insights and recommendations to leadership in a clear, concise, and data-driven manner
Lead cross-functional collaboration with IT, data engineering, operations, and quality teams to improve data architecture and reporting accessibility.
Mentor junior analysts and strengthen analytics capabilities across teams.
Drive automation of manual reporting workflows and implementation of scalable reporting solutions.
Establish documentation standards, reporting governance processes, and analytics best practices.
Support integration of AI tools into technical operations
Perform other duties as needed
Required Qualifications
Bachelor's degree (or equivalent experience) in public health, data analytics, health informatics, business, or a related field.
8+ years of experience with advanced proficiency in SQL, Excel, and Power BI/Tableau in healthcare analytics environments
5+ years of experience working with healthcare datasets, including claims, utilization management/prior authorization, care management, and quality measures.
Demonstrated leadership managing analytics teams
Strong understanding of clinical workflows, utilization and network management analytics, and healthcare economics.
Demonstrated ability to translate complex analytics into executive-level insights and operational recommendations.
Experience developing presentation materials that articulate insights clearly and persuasively
Displays willingness and ability to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions
Strong analytical mindset with intellectual curiosity and a passion for problem-solving.
Superior attention to detail and strong organizational skills, with the ability to operate effectively in a fast paced, high demand environment while managing multiple priorities
Exceptional verbal and written communication skills, with a bias toward clarity, brevity, and decisive communication
Preferred Qualifications
Experience with data science tools and programming languages such as Python or R.
Experience incorporating AI into analytics workflows
