The Director, Data Engineering Analysis is a hands-on analytical leader responsible for driving end-to-end data requirements, quality, and operational insight across our Medicare Advantage platform. This role works closely with operational, clinical, actuarial, and technology stakeholders to ensure data assets are accurate, trusted, and fit for decision-making at all levels of the organization. The Director leads the data analysis team, resolves production and customer-facing data issues, and champions continuous improvement in data quality and interoperability standards. Success in this role is measured by the reliability of data outputs, the speed and quality of issue resolution, and the team's ability to deliver trusted analytics that drive business outcomes.
Job Duties / Responsibilities(May include but are not limited to)
- Lead Data Requirements & Stakeholder Analysis - Partner with operational, analytical, and platform stakeholders to define, gather, and translate end-to-end data requirements into actionable specifications that meet both business and technical needs.
- Drive Data Quality & Continuous Improvement - Initiate and sustain data quality improvement processes across health plan data domains, including claims, membership, member, and provider data, ensuring completeness, accuracy, and consistency.
- Own Data Operations & Issue Resolution - Direct the triage, analysis, and resolution of Data Ops issues affecting production environments and customer-facing outputs, minimizing disruption to plan operations.
- Apply Healthcare Data Standards & Interoperability - Serve as the subject matter authority for EDI and healthcare data standards including X12 834/837 transactions, claims, membership, and provider domains, ensuring data interoperability across systems and partners.
- Evaluate Data Sources for Completeness & Fitness - Assess internal and external data sources for quality, coverage, and suitability to support analytical, operational, and regulatory use cases across Medicare Advantage lines of business.
- Enable the Data Platform - Apply working knowledge of cloud data platforms, streaming architectures, automation, and data quality as a service to support scalable, modern analytics infrastructure in partnership with data engineering.
- Develop and Mentor the Data Analysis Team - Build team capability through active mentorship, coaching, and change leadership, fostering a culture of analytical rigor, intellectual curiosity, and continuous learning.
Supervisory Requirements: Fulfill supervisory responsibilities in accordance with organization policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Job Requirements Required: - 8-10 years of progressive experience in data analysis, data operations, or data management roles, with at least 3 years in a leadership or senior individual contributor capacity.
- Demonstrated experience in a healthcare payer, managed care, or Medicare Advantage environment, with direct exposure to health plan data domains.
- Proven hands-on experience leading data requirements gathering and quality improvement across complex, multi-domain data environments.
- Experience resolving production and operational data issues in regulated, time-sensitive environments.
Preferred: - Experience working within or alongside data platform and engineering teams in a cloud-based data ecosystem (Azure, AWS, or GCP).
- Experience in a data analysis or data operations capacity supporting risk adjustment, HEDIS, Star Ratings, or encounter data submission workflows.
- Experience building or scaling a data analysis team or function within a health plan or insurance organization.
Education Required: - Bachelor's degree in Computer Science, Information Systems, Data Science, Health Informatics, Statistics, or a related field.
- An equivalent combination of education and demonstrated professional experience will be considered.
Preferred: - Master's degree in Data Science, Health Informatics, Business Analytics, or a related discipline.
Training Required: - Demonstrated proficiency with SQL and at least one BI/reporting tool (e.g., Power BI, Tableau, SSRS) through work experience or equivalent training.
- Working familiarity with healthcare data file formats and standards (EDI, HL7, X12, custom file formats) demonstrated through direct experience.
Preferred: - Formal training or certification in data governance, data quality, or healthcare informatics (e.g., CDMP, CHDA, or equivalent).
- Training in DataOps, Agile data delivery, or cloud data platform administration.
Skills & Competencies Technical / Role-Specific Skills - Healthcare Data Standards & Interoperability - Deep knowledge of X12 EDI (834/837), HL7, FHIR, and healthcare data domains including claims, membership, member, and provider; experience with data interoperability across payer systems and partners.
- Data Quality Analysis & Improvement - Proficiency in evaluating data sources for completeness, accuracy, and fitness; ability to design and operationalize data quality rules, monitoring, and remediation workflows.
- SQL & Data Querying - Advanced SQL skills for data extraction, validation, analysis, and operational troubleshooting across relational and cloud-based data platforms.
- BI & Data Visualization Tools - Proficiency in Power BI, Tableau, or comparable platforms for building dashboards and communicating data insights to operational and senior business audiences.
- Cloud Data Platform Literacy - Working knowledge of cloud data ecosystems (Azure, AWS, or equivalent), streaming architectures, and data quality automation capabilities.
- Stakeholder Requirements Translation - Demonstrated ability to gather complex analytical and operational requirements from cross-functional stakeholders and convert them into clear, actionable data specifications.
- Medicare Advantage / Health Plan Domain Knowledge - Working knowledge of Medicare Advantage plan operations, CMS regulatory requirements, and data flows across health plan functions (clinical, actuarial, network, operations).
Licensure Required: None.
Preferred: - Certified Data Management Professional (CDMP) or Certified Health Data Analyst (CHDA).
Essential Physical Functions The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $172,364.00 - $258,547.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
