Data Analyst III (Healthcare Analytics)

Key Skills

Apache Hadoop, C Programming, C++, Data science techniques, Java Programming, Machine learning techniques, MapReduce, Python Programming, PyTorch, R Programming, Scala Programming, SQL, TensorFlow

Job Description

Job Req. ID: 1220343 | WellCare of North Carolina

Position Purpose:

• Interpret and analyze data from multiple sources including claims, provider, member, and encounters data. Identify and assess the business impact of trends
• Develop, maintain, and troubleshoot complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools
• Contribute to the planning and execution of large-scale projects with limited direction from leadership
• Assist in the design, testing, and implementation of process enhancements and identify opportunities for automation
• Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers
• Manage multiple, variable tasks and data review processes with limited supervision within targeted timelines and thrive in a demanding, quickly changing environment
• Apply expertise in quantitative analysis, data mining, and the presentation of data to see beyond the numbers and understand how customers interact with analytic products
• Partner cross-functionally at all levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
• Independently engage with customers and business partners to gather requirements and validate results
• Communicate and present data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required
• Provide technical guidance to junior analysts
• The Data Analyst (Healthcare Analytics) will have the opportunity to make a significant impact through the discovery, development, and implementation of leading-edge analytics that answer important business questions. The analyst will collaborate with key corporate and health plan business partners for the purpose of identifying and delivering robust reporting and analytics capabilities to drive improved business performance.

Education/Experience:

Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field or equivalent experience. Master's degree preferred. 4+ years of experience working with large databases, data verification, and data management or 2+ years of IT experience. Healthcare analytics experience preferred. Ability to integrate, validate, and reconcile data from multiple sources as well as design and construct analysis tools that extract, prepare, analyze, and store/present results to support business needs. Knowledge of query development using SQL or other coding languages. Knowledge of basic statistical, analytical, or data mining techniques including basic data modeling, trend analysis, and root-cause analysis preferred. Working knowledge of analytical tools, including R, Python, SAS, ArcGIS, QGIS, Microstrategy, Tableau, Hadoop, or related tools preferred. Working knowledge of relational databases preferred. Working knowledge of automation capabilities such as batch processes, stored procedures, scripting languages, Microstrategy, or other tools preferred.

Provider

Experience in provider contracting, claims pricing, financial reporting/analysis, data modeling, statistical modeling, data science, or geospatial/reimbursement analysis preferred

Clinical

Experience in public health (epidemiology, biostatistics), population health, social determinants of health, data science, social science, or geospatial/ROI/financial analysis preferred

Finance

Experience working closely with accounting & finance business partners, using analytic techniques & tools to explore financial performance trends, or regulatory reporting with external agencies preferred; Familiarity with claims data, utilization, rate setting, risk adjustment, or member eligibility and reconciliation preferred

Fraud, Waste & Abuse

Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred; Experience with data mining, machine learning, artificial intelligence, or statistical modeling preferred

Risk Adjustment

Experience in risk adjustment, clinical coding, financial reporting/analysis, or CMS/State encounters and regulatory file submissions preferred; Experience with data mining, population health, and statistical modeling preferred

Quality

Experience with HEDIS, NCQA, Medicare Star Rating System, QRS, or other quality measures preferred; Quality auditing or analysis of call center performance preferred; Experience with data mining, population health, and statistical modeling preferred

Tools & Technology

Experience with report/dashboard development, data/report automation, self-service capabilities, data design and integration, or data quality and governance preferred