Network Operations Analyst

Triple-S; Guaynabo (PR); On-site; USD 50,000 - 65,000; Full time

Job summary

Triple-S is seeking an analyst to evaluate provider network adequacy and operational workflows within a healthcare environment in Guaynabo. The role involves data analysis, report generation, and collaboration with Provider Network and Operations to support regulatory compliance and performance improvement.

The ideal candidate will have a Bachelor’s degree in Mathematics or Finance and 1-3 years of experience in the Health Insurance Industry. The position offers opportunities to innovate reporting capabilities in a dynamic healthcare setting.

Qualifications

• 1-3 years of experience in the Health Insurance Industry preferred.
• Experience in data analysis and report generation.

Responsibilities

• Analyze provider network adequacy and operational workflows.
• Develop, maintain, and automate reports and dashboards.
• Ensure data integrity across multiple healthcare data sources.

Skills

Data analysis

Report generation

Data visualization

Healthcare knowledge

Education

Bachelor's Degree in Mathematics or Finance

Bachelor’s degree in Biostatistics, Mathematics, Finance or related field

Job description

Job Summary

Responsible for analyzing and translating complex provider network and operational data into actionable insights that support performance improvement and regulatory compliance. This role focuses on evaluating provider network adequacy, access to care, utilization trends, and operational workflows within a healthcare environment. The analyst will design and deliver reports, dashboards, and data visualizations to monitor key performance indicators, including provider availability, geographic access, case turnaround times (TAT), and provider onboarding metrics. This role partners closely with Provider Network, Operations, and Leadership to ensure data-driven visibility into network performance, support strategic decision-making, and continuous improvement initiatives aligned with healthcare regulations, best practices and standards.

Essential Functions

• Develops, maintains, and automates new reports, dashboards, and other means to enable transparency and monitor network management operational processes. Provides timely information to management regarding status of compliance with guidelines, rules-regulations and internal policies and procedures and assists with decision-making and tracking accountability.
• Analyzes provider network adequacy, including geographic distribution, provider-to-member ratios, and compliance with access standards, such as time and distance requirements.
• Generates reports on provider availability and accessibility by specialty, region, and line of business.
• Evaluates provider utilization trends, including patterns by specialty, primary care providers (PCPs), and service areas.
• Monitors and reports on key operational metrics such as case volumes, turnaround times (TAT), provider onboarding timelines, and case closure rates. Track and analyze provider-related interventions, outreach efforts, and network development activities to assess impact on access and performance.
• Ensures data integrity and consistency across multiple healthcare data sources, including claims, providers data, and operational systems. Monitors data quality and reliability and creates solutions to proactively address and resolve data quality inconsistencies.
• Supports compliance reporting and audits by ensuring accuracy and completeness of data related to provider networks and access to care.
• Prepares and responds Ad-Hoc reporting requests as needed for specific situations, such as other departments, auditors, and external regulators.
• Designs and delivers executive-level dashboards and presentations that communicate key trends, risks, and opportunities related to network performance.
• Translates complex healthcare data into clear, concise insights for technical and non-technical stakeholders.
• Continuously enhances reporting capabilities through automation, standardization, and implementation of data analytics best practices.

Education

• Bachelor's Degree in Mathematics or Finance

Experience

Bachelor’s degree in Biostatistics, Mathematics, Finance or related field, preferable, with one (1) to (3) three years of experience in the Health Insurance Industry preferred.

Licenses and Certifications

• None required

Competencies

No competencies listed.