Data Analyst

Role and Responsibilities

The Data Analyst will support data-driven decision-making across a Third-Party Administrator (TPA) environment by analyzing complex datasets for multiple health plans, including Medicare, Medicaid, and self-funded commercial insurance. This role focuses heavily on Provider data (e.g., contracts, performance, network participation, credentialing, reimbursement, and utilization), while also supporting broader Payer and plan-level analytics to meet client, regulatory, and operational needs.

Essential Functions/Responsibilities

Provider & Network Analytics:

• Analyze provider data including demographics, specialties, contracts, credentialing status, network participation, and performance metrics across multiple plans
• Support provider network management initiatives such as network adequacy, access analysis, and provider performance benchmarking for Medicare, Medicaid, and self-funded clients
• Identify trends and anomalies in provider utilization, reimbursement, quality, and cost across plan types and employer groups

Claims & Plan Data Analysis:

• Analyze medical and pharmacy claims data across Medicare, Medicaid, and self-funded commercial plans to identify cost drivers, utilization patterns, and opportunities for improvement
• Support client reporting and internal stakeholders with plan-level, employer-level, and provider-level analytics
• Develop reports and dashboards tailored to diverse client and regulatory requirements

Data Management & Reporting:

• Extract, transform, validate, and reconcile data from multiple sources including claims systems, provider databases, eligibility files, and data warehouses
• Ensure data accuracy, integrity, and consistency across plans, clients, and reporting deliverables
• Create recurring and ad-hoc reports using SQL, BI tools, and spreadsheets

Insights, Compliance & Client Support:

• Translate complex data into actionable insights for internal teams and external clients
• Support regulatory, audit, and accreditation reporting (e.g., CMS, state Medicaid agencies) as applicable
• Assist with responses to client data requests, performance guarantees, and operational inquiries

Collaboration & Continuous Improvement:

• Partner with Provider Relations, Network Management, Client Services, Finance, Actuarial, Compliance, and IT teams
• Help define data requirements for new clients, plans, and employer groups
• Contribute to data governance, documentation, and continuous process improvement initiatives

Required Qualifications:

• Bachelor’s degree in Data Analytics, Statistics, Mathematics, Health Informatics, Business, or a related field
• 2+ years of experience as a data analyst, preferably in a TPA, health plan, managed care, or healthcare services organization
• Strong SQL skills and experience working with large, complex relational datasets
• Experience analyzing healthcare data such as claims, provider, eligibility, or financial data
• Proficiency in Excel and at least one BI or visualization tool (e.g., Power BI, Tableau, Looker)
• Experience working in a TPA environment supporting multiple plan types (Medicare, Medicaid, self-funded commercial)
• Strong understanding of provider data including contracts, credentialing, network participation, and reimbursement models
• Familiarity with healthcare coding and standards (CPT, HCPCS, ICD-10, DRG, NPI)
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office Suite, TEAMS and Power BI Reporting.

Competencies:

• Strong analytical and critical-thinking skills
• High attention to detail and data accuracy across multiple clients and plans
• Ability to clearly communicate insights to technical and non-technical audiences
• Strong organizational skills and ability to manage competing priorities
• Understanding of TPA operations, client reporting, and provider relationships

Additional Notes:

• Fast-paced, multi-client environment with periodic deadlines working in office.

Job Type: Full-time

Benefits:

• AD&D insurance
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Prescription drug insurance
• Retirement plan
• Vision insurance

Education:

• Bachelor's (Required)

Experience:

• SQL: 7 years (Required)
• Power BI, Tableau or Looker: 7 years (Required)

Work Location: In person