Senior Health Insurance Data Analyst

Freddie Mac; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Senior Health Insurance Data Analyst to drive data-informed decision-making in healthcare. This role involves leveraging analytical expertise and technical skills to enhance operational efficiency and improve healthcare outcomes. You will work with large datasets, applying advanced analytics techniques to identify strategic insights and support product growth. If you are passionate about making a difference in healthcare and possess strong problem-solving skills, this opportunity offers a chance to impact millions positively while working in a collaborative environment that values diversity and inclusion.

Benefits

Flexible work solutions

Remote options

Health insurance coverage from Day 1

401(k)

Tuition reimbursement

Paid time off

Holidays

Volunteer events

Qualifications

• 3+ years in healthcare claims analysis and data analytics.
• Proficiency in SQL and SAS for data querying and analysis.
• Experience with data visualization tools like Tableau and Power BI.

Responsibilities

• Develop data-driven strategies to enhance financial performance.
• Utilize SQL/SAS for analyzing Medicare and Medicaid claims data.
• Collaborate with cross-functional teams to optimize claims workflows.

Skills

SQL

SAS

Data Analysis

Predictive Modeling

Statistical Analysis

Data Visualization

Problem-Solving

Education

Bachelor's degree in healthcare administration

Bachelor's degree in computer science

Bachelor's degree in data analytics

Bachelor's degree in business

Tools

Tableau

Power BI

Looker

ETL processes

Job description

Your career starts now. We're looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Position Overview: Reporting to the Corporate Director of Health Insurance Data Strategy, the Senior Health Insurance Data Analyst plays a crucial role in driving data-informed decision-making to enhance performance across Specialty Products & Network. This position combines analytical expertise, technical proficiency in health insurance data, and strategic insight to support product growth, operational efficiency, and improved healthcare outcomes. The Analyst utilizes data analytics, predictive modeling, and business intelligence to generate insights, influence decisions, and promote innovation within the Specialty Products lines of business.

Key Responsibilities:

Strategic Data Analytics and Insights:

• Develop and execute data-driven strategies to improve financial performance, operational efficiencies, and healthcare quality across Specialty Products.
• Utilize SQL and/or SAS to extract and analyze data related to Medicare and Medicaid claims, enrollment, risk adjustment, provider networks, and utilization trends to identify key strategic insights.
• Identify and assess business opportunities and risks using predictive modeling, statistical analysis, and data visualization.
• Develop and document business rules, methodologies, and best practices for claims analysis.

Technical and Analytical Expertise

• Work with large datasets, integrating multiple data sources (claims, financials, provider networks, social determinants of health, etc.) to identify patterns, trends, and opportunities for strategic process improvement.
• Apply advanced analytics techniques, including AI and statistical modeling, to advance key business initiatives.
• Conduct root cause analysis on claim denials, payment delays, and billing discrepancies.
• Ensure accurate processing and adjudication of claims while identifying errors, anomalies, and potential fraud.
• Develop and maintain dashboards and reporting tools using business intelligence (BI) tools (Tableau, Power BI, Looker, etc.) to support business decisions and for departmental and functional meetings. Provide ad-hoc reports and support to stakeholders as needed.
• Collaborate with IT and data engineering to ensure data integrity, governance, and compliance with HIPAA and other regulatory standards.

Business and Cross-Functional Collaboration:

• Partner with actuarial, finance, operations, clinical, and IT teams to align data strategies
• with business objectives. Collaborate with cross-functional teams, including Operations
• Specialty Products, finance, compliance, and IT, to optimize claims processing workflows.
• Drive collaborative initiatives to enhance risk stratification, population health management, and value-based care performance.
• Communicate complex data insights to stakeholders in a clear and actionable manner.

Performance Optimization and Innovation:

• Identify opportunities for automation, process improvement, and operational efficiencies.
• Stay ahead of industry trends, emerging technologies, and regulatory changes impacting
• health insurance and data analytics.
• Monitor and interpret CMS (Centers for Medicare & Medicaid Services) policies and regulatory updates to ensure compliance.
• Support system migrations, implementations, and upgrades related to claims processing

Education & Experience:

• Bachelor's degree in healthcare administration, computer science, data analytics, business, or another related field.
• 3 or more years of experience in the healthcare/managed care industry.
• 3 or more years of experience in healthcare claims analysis, data analytics, or a data strategy-related role.
• Proficiency in SQL (T-SQL, PL/SQL, or similar) and/or SAS for querying and analyzing claims data. Knowledge of Tableau, Power BI, or other data visualization tools
• Proven experience in interpreting complex data sets and presenting insights to non-technical stakeholders.
• Experience with ETL processes, data validation, and data governance best practices.
• Strong problem-solving skills and attention to detail.
• Advanced analytical and quantitative skills with experience collecting, organizing, mining, analyzing, visualizing, and disseminating abundant information with the utmost accuracy and presentation.
• Prior experience in developing and implementing standards in a regulated environment.
• Ability to multi-task, manage time based on continually evaluating priorities, and meet deadlines with high-quality deliverables reflecting complete understanding of expectations.
• Collaborate, influence, project confidence, identify organizational needs, and convincingly present statistical information, data analysis, and recommendations.
• Strong analytical, problem-solving, communication/presentation, and attention to detail skills.

Strongly Preferred:

• Experience with healthcare claims adjudication systems (e.g., Facets, Amisys, QNXT, Epic, or similar).
• Knowledge of Tableau, Power BI, or other data visualization tools.
• Experience with predictive analytics, machine learning models, or risk adjustment methodologies in healthcare.
• Strong understanding of Medicare and Medicaid claims processing, billing codes (ICD-10, CPT, HCPCS), and reimbursement methodologies.
• Experience with healthcare payer systems, managed care organizations (MCOs), and provider networks.
• Knowledge of CMS regulations, HIPAA compliance, and healthcare data security.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays, and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.