Network Operations Analyst

Triple-S Management Corp.; Northern (KY); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Triple-S Management Corp. is seeking a healthcare data analyst to translate complex provider network data into actionable insights and dashboards for performance improvement and regulatory compliance.

You will design, deliver, and automate reports to monitor provider availability, access, and utilization, partnering with Network, Operations, and Leadership to drive data-driven decisions.

Qualifications

• Bachelor’s degree in Mathematics or Finance.
• One to three years of experience in the Health Insurance Industry preferred.
• Strong analytical and reporting capabilities.

Responsibilities

• Develop, maintain, and automate reports, dashboards, and data visualizations to monitor provider network performance.
• Analyze provider network adequacy, geographic distribution, and access standards.
• Generate reports on provider availability and utilization by region and line of business.
• Evaluate provider onboarding timelines and case turnaround times (TAT).
• Ensure data integrity across claims, providers, and operational systems and address data quality issues.
• Support compliance reporting and audits with accurate data for regulators and internal teams.

Education

Bachelor's Degree in Mathematics or Finance

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

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, Mathematic, 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

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Veterans and Disabled to Apply.