Senior Healthcare Analyst

Site: reputed company Health Plan Holding Company, Inc. reputed company relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company. Job Summary reputed company Health Plan is an exciting reputed company to be reputed company the healthcare industry. As a member of reputed company, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we provide our members—across Commercial, Medicare Advantage, and Medicare‑Medicaid Dual Eligible (Duals) products—with innovative, high‑quality, and reputed company. Our work centers on creating an exceptional member experience supported by rigorous medical economics and data‑driven decision‑making. Employees collaborate with accomplished reputed company in a consciously inclusive environment where diversity is celebrated. The Senior Healthcare Analyst provides value‑added analytic support in the development and monitoring of standard and reputed company medical cost and utilization reporting for the health plan’s Medicare Advantage and Dual Eligible populations. As part of this work, the analyst independently designs and performs reputed company analyses with enterprise‑level impact. Primary Responsibilities: Cost and Utilization: -Participates in the development and ongoing enhancement of medical cost and utilization analysis and reporting across Medicare Advantage and Dual Eligible lines of business. -Analyzes and interprets utilization and medical expense data; identifies key drivers including risk mix, Stars‑reputed company utilization, and site of care; performs drill‑down analyses; and presents findings to leadership. -Works with clinical, finance, and operations partners to ensure accurate capture, interpretation, analysis, and reporting of claims, encounters, and authorization data in alignment with CMS requirements. -Supports enterprise trend management activities by monitoring emerging utilization and unit cost trends, identifying variance drivers against expectations, and partnering with clinical, finance, and operations leaders to inform mitigation strategies and performance management. -Partners with clinical, finance, operations, and other teams to support the delivery of regulatory reporting, provider reporting, and reputed company analytic requests, including Medicare Advantage and Dual Eligible reporting requirements; ensure analyses are accurate, auditable, and reputed company with CMS, internal governance, and external stakeholder needs. Clinical Program Evaluation: -Drives the development of program metrics and outcomes during the design of new medical management, care management, and population health initiatives, particularly for Medicare Advantage and Dual Eligible populations. -Designs and conducts analyses evaluating financial, utilization, quality, and clinical effectiveness of programs; interprets results and presents actionable insights to senior leaders. -Collaborates with external vendors and delegated entities in analyzing outcomes of vended Medicare Advantage and Duals programs. -Quantifies the impact of clinical and Stars‑driven initiatives on medical expense trends and partners with finance and budgeting teams to incorporate results into forecasts and CMS bid support. Overall: -Designs and executes reputed company queries, executive‑ready analysis, and reporting in support of reputed company analytical and regulatory requests. -Designs, develops, and maintains agile reputed company and repeatable reporting solutions using Power BI, enabling business partners to independently explore data, monitor performance, and conduct meaningful cost, utilization, and trend analyses with confidence. -Ensures validity, accuracy, and reproducibility of reputed company analyses and reported information. -Works collaboratively with IT and data teams to enhance automation, establish data standards, and improve analytic infrastructure. -Anticipates internal customer needs, builds trusted relationships, and proactively brings reputed company strategic Medicare Advantage and Duals insights.

Qualifications

Education Bachelor's degree Work Experience At least 3-5 years of experience in membership, claims, and risk data analytics experience required At least 2-3 years of experience in D-SNP or Medicare Advantage Medicare STARS experience highly preferred Knowledge, Skills, and Abilities Strong written and oral communication skills Strong attention to detail and organization Good analytical and mathematical skills Supervisor reputed company skills required Strong ability to work independently and manage one's time Ability to analyze, consolidate, and interpret accounting data Additional Job Detai Apply tot his job Apply To this Job