Description

The Senior Consultant will work with cross-functional teams in a centralized consulting role supporting multiple client engagements and internal operational initiatives. The Senior Consultant is responsible for independent ownership of major analytical workstreams as well as defining methodology and reporting logic. This includes, but is not limited to, designing, developing, maintaining, and executing healthcare analytics and reporting solutions that enable clients and internal leadership to evaluate performance, identify opportunities, and improve outcomes across value-based care programs.

This position partners closely with consulting, product, engineering, clinical, and client stakeholders to translate complex healthcare data into meaningful insights that drive operational efficiency, quality improvement, utilization management, care management performance, risk adjustment optimization, and financial success. The ideal candidate must be accountable for deliverable quality and deadlines, comfortable with direct presentation to client executives, possesses deep healthcare data expertise, SQL development skills, strong analytical thinking, and an ability to leverage AI-enabled technologies to improve reporting and analytics capabilities.

FLSA Status

Exempt

Salary Range

$111,600 - $139,400

Reports To

Director, Medical Economics

Direct Reports

None

Location

Hybrid in LA/NY Office

Travel

Up to 40%

Work Type

Regular

Schedule

Full Time

Position Description

• Design, develop, automate, maintain, and execute client-facing and internal dashboards, reports, scorecards, and recurring analytics supporting value-based care initiatives.

• Translate client and stakeholder business requirements into scalable reporting and analytical solutions using SMSS SQL, Excel, and other business intelligence tools.
• Analyze healthcare claims, EMR, and operational datasets to identify actionable opportunities related to quality performance, care management, utilization management, prior authorization, HCC risk adjustment, population health, and medical cost/utilization.
• Develop executive-ready reporting that highlights operational efficiencies, outcomes, successes, failures, emerging trends, and strategic opportunities.

• Validate healthcare data for completeness, accuracy, consistency, and adherence to business rules while ensuring reporting integrity and reproducibility.

• Collaborate with product, engineering, consulting, and implementation teams to map client-specific data elements and define reporting logic aligned with client requirements.

• Investigate data anomalies, perform root cause analyses, and recommend solutions that improve data quality and accurate reporting.

• Support implementation of new reporting capabilities for value-based care programs including MSSP, ACO REACH, Medicare Advantage, Commercial Risk, and Medicaid value-based arrangements.

• Present analytical findings to both technical and executive audiences in a clear, actionable manner.

• Utilize AI-enabled technologies to accelerate report development, optimize SQL coding, improve documentation, automate repetitive analytical processes, and identify innovative opportunities for enhancing client value.

• Contribute to continuous improvement initiatives that modernize analytics capabilities, increase operational efficiency, and strengthen consulting delivery.

• Review or quality oversight of junior team members.

• Project leadership or information mentorship.

Qualifications

• Graduate degree with a quantitative, healthcare, business or technical focus preferred, bachelor's degree and applicable experience will be considered.

• 3+ years of professional experience performing healthcare analytics within a consulting firm, health system, payer, accountable care organization, or healthcare technology organization.

• Demonstrated experience working with healthcare claims and eligibility data (professional, institutional, and pharmacy).

• Experience with Electronic Medical Record (EMR/HER) and Utilization Management and Prior Authorization datasets preferred

• Proficiency in SQL

• Familiarity of data visualization and Business Intelligence platforms

• Working knowledge of value-based care programs and healthcare risk-based arrangements including MSSP, ACO REACH, Medicare Advantage, and alternative payment models.

• Experience supporting HCC Risk Adjustment, quality, care management reporting, and utilization management analytics.

• Strong consulting, project management, and stakeholder relationship management skills.

• Experience utilizing AI technologies (e.g., ChatGPT, Microsoft Copilot, Claude, GitHub Copilot, or similar tools) to improve analytics development, SQL optimization, reporting automation, and operational efficiency.

• Excellent written and verbal communication skills with the ability to explain technical concepts to both technical and business audiences.

Benefits

As a firm passionate about health care, we're deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/

To Apply: To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/