Operations Data Analyst

Position Summary

The Operations Data Analyst supports commercial and government health plan operations by collecting analyzing and presenting data to support business decision making, ensuring accuracy, compliance and actionable insights. These tasks are focused on analyzing claims, eligibility, provider and financial data to drive performance, compliance and client reporting. This role bridges operational workflows with analytics, ensuring accuracy, efficiency, regulatory adherence, and service excellence.

The Analyst partners with Claims, Provider Data, Finance, Compliance, and Client Services to monitor key performance indicators (KPIs), identify trends, support audits, and improve operational processes.

KEY RESPONSIBILITIES

• Gathering data from multiple sources, analyzing and creating reports, dashboards and visualizations to communicate to stakeholders across departments.
• Designing and generating regular and ad-hoc reports using tools like SQL, Excel and Power BI
• Ensuring data accuracy and integrity through validation and quality control processes
• Analyze encounter, claims, provider, and member data.
• Provide data to stakeholders to meet auditor request
• Assist with CMS, Medicare Advantage, and commercial plan reporting
• Support internal audits and external regulatory reviews
• Maintain documentation supporting SPD compliance, contractual obligations, and reporting deliverables
• Monitor operational adherence to state and federal requirements
• Review and provide client reporting on MAO002 encounter data processing reports.
• Ensure compliance with data privacy regulations (e.g., HIPAA) and CMS encounter data processing rules and regulations.
• Submission of corrections and resubmission of encounters through the encounter data processing system platform.

QUALIFICATIONS

• Bachelor’s degree in Healthcare Administration, Business, Finance, Data Analytics, or related field (or equivalent experience)
• 2–3 years in health plan operations, analytics, or a similar role
• Experience with claims systems and benefit configuration
• Analytical skills to interpret complex data and identify trends
• Familiarity with Medicare Advantage and self-funded plans preferred
• Experience with stop-loss reporting a plus
• Understanding of claims adjudication logic and benefit design
• Advanced Excel: formulas, pivot tables, and VLOOKUP/XLOOKUP for ad-hoc analysis
• Understanding of medical coding, claims and member data, and risk adjustment
• Knowledge of HIPAA compliance standards

CORE COMPETENCIES

• Ability to manage multiple priorities in a fast-paced TPA environment
• Analytical thinking with strong attention to detail
• Ability to translate data into operational insight
• Advanced data and reporting acumen
• Regulatory awareness
• Strong organizational and documentation skills
• High accountability and attention to detail
• Clear and professional communication skills

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have a minimum of two (2) years' experience in health plan operations, analytics or a similar role?
• Do you advanced Excel experience including formulas, pivot tables, and VLOOKUP/XLOOKUP for ad-hoc analysis?
• Are you familiar with Medicare Advantage and self-funded plans?

Education:

• Bachelor's (Preferred)

Work Location: In person