Healthcare Economics Data Analyst II

Clever Care Health Plan; Huntington Beach (CA); Hybride; USD 82 000 - 100 000; Plein temps

Résumé du poste

Clever Care Health Plan is seeking an experienced healthcare analytics professional to own and execute analyses across cost, utilization, and population health outcomes. You’ll build dashboards and automated reporting, develop reusable data models, and support risk adjustment and Stars/Quality initiatives.

Work will be conducted in Huntington Beach, CA, in a hybrid model requiring three onsite days. Strong SQL, Excel, and Power BI skills, along with experience in Medicare Advantage or managed

Qualifications

• Bachelor’s degree in a related field.
• 3 to 5 years of experience in healthcare analytics or managed care reporting.
• Experience with SQL, Excel and Power BI or comparable tools.
• Experience analyzing claims, membership, pharmacy, utilization, risk adjustment, quality, or population health data.
• Medicare Advantage or managed care experience strongly preferred.
• Intermediate to advanced skills in SQL, Excel, data visualization, and relational databases.

Responsabilités

• Independently design and complete moderately complex analyses across cost, utilization, unit cost, service mix, pharmacy spend, membership, risk scores, quality performance, and population health outcomes.
• Own recurring dashboards, scorecards, worklists, and reporting packages from data extraction through validation, interpretation, and delivery.
• Build reusable SQL queries, data models, business rules, and automated reporting processes.
• Conduct drill-down analyses by provider, medical group, product, region, risk type, member segment, diagnosis, procedure, and site of care.
• Support risk adjustment financial analytics, including RAF trend, suspect and recapture opportunities, coding pattern, submission status, and intervention performance.
• Support Stars/Quality analyses, including measure performance, care gaps, provider variation, intervention targeting, and outcome tracking.
• Develop population health cohorts, including risk stratification, chronic-condition prevalence, avoidable utilization, outreach prioritization, and pre/post program evaluations.
• Evaluate care management, pharmacy, quality, vendor, and culturally attuned benefit programs using utilization, engagement, outcome, satisfaction, and financial measures.
• Investigate data anomalies, reconcile multiple sources, assess limitations, and recommend corrective actions.
• Present findings and recommendations to managers and cross-functional partners; contribute to executive-ready materials.
• Gather requirements, define metrics, manage project timelines, and communicate risks or dependencies.
• Provide peer review and technical guidance to Level I analysts.
• Maintain compliance with HIPAA, CMS, corporate, and departmental requirements.

Connaissances

SQL

Excel

Power BI

Data viz

Relational databases

Formation

Bachelor’s degree

Description du poste

Own recurring healthcare economics analytics and translate results into actionable recommendations for business and clinical teams.

Responsibilities

• Independently design and complete moderately complex analyses across cost, utilization, unit cost, service mix, pharmacy spend, membership, risk scores, quality performance, and population health outcomes.
• Own recurring dashboards, scorecards, worklists, and reporting packages from data extraction through validation, interpretation, and delivery.
• Build reusable SQL queries, data models, business rules, and automated reporting processes to improve timeliness and consistency.
• Conduct drill-down analyses by provider, medical group, product, region, risk type, member segment, diagnosis, procedure, and site of care.
• Support risk adjustment financial analytics, including RAF trend, suspect and recapture opportunities, coding pattern, submission status, and intervention performance.
• Support Stars/Quality analyses, including measure performance, care gaps, provider variation, intervention targeting, and outcome tracking.
• Develop population health cohorts, including risk stratification, chronic-condition prevalence, avoidable utilization, outreach prioritization, and pre/post program evaluations.
• Evaluate care management, pharmacy, quality, vendor, and culturally attuned benefit programs using utilization, engagement, outcome, satisfaction, and financial measures.
• Investigate data anomalies, reconcile multiple sources, assess limitations, and recommend corrective actions.
• Present findings and recommendations to managers and cross-functional partners; contribute to executive-ready materials.
• Gather requirements, define metrics, manage project timelines, and communicate risks or dependencies.
• Provide peer review and technical guidance to Level I analysts.
• Maintain compliance with HIPAA, CMS, corporate, and departmental requirements.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree in Healthcare Administration, Finance, Economics, Actuarial Science, Statistics, Data Analytics, Public Health, Business, Information Systems, or a related field.
• 3 to 5 years of experience in healthcare analytics, healthcare economics, financial analytics, or managed care reporting.
• Demonstrated experience with SQL, Excel, and Power BI or a comparable reporting tool.
• Experience analyzing claims, membership, pharmacy, utilization, risk adjustment, quality, or population health data.
• Medicare Advantage or managed care experience strongly preferred.
• Intermediate to advanced skills in SQL, Excel, data visualization, and relational databases.
• Strong analytical and critical-thinking skills, including trend, variance, cohort, and financial-impact analysis.
• Working knowledge of Medicare Advantage economics, claims, risk adjustment, Stars/Quality, population health, and value-based care concepts.
• Ability to translate complex analyses into clear conclusions, limitations, and recommended actions.
• Strong project management, documentation, stakeholder communication, and presentation skills.
• Ability to work independently, prioritize competing assignments, and provide constructive peer review.
• High attention to data integrity, confidentiality, and compliance.

Technologies

• SQL
• Excel
• Power BI

Work Location and Schedule

• Huntington Beach, CA (hybrid).
• Hybrid work schedule.
• Requires 3 days onsite at the Huntington Beach office.

Compensation

• $81,500/year to $100,000/year.
• Salary ranges reflect California wages; compensation may vary based on state residency.

Physical and Working Environment

• Office environment and/or remote hybrid setting.
• Ability to operate a keyboard, mouse, and phone; perform repetitive motion; sit for long periods; stand, reach, bend; and lift up to 15 lbs.
• Ability to convey information and detailed instructions accurately.
• May occasionally require irregular hours based on business needs.

Equal Employment Opportunity

• Clever Care Health Plan is an Equal Employment Opportunity and Affirmative Action workplace.
• Background check required.