Health Insurance Data Analyst or Senior

The Health Insurance Data Analyst performs midlevel health insurance plan management work to ensure the plan is running efficiently benefits are being administered appropriately and to promote the longterm stability of the health insurance plans.

The position involves analyzing healthcare data and reporting monitoring the performance of plan administrators and assisting with procurement and contract documents. This role requires solid analytical communication writing and project coordination skills with opportunities to develop leadership capabilities while contributing to initiatives that enhance health plan efficiency and performance.

The Senior Health Insurance Data Analyst performs complex health insurance plan management work to ensure the plan is running efficiently benefits are being administered appropriately and to promote the longterm stability of the health insurance plans.

The position involves conducting and synthesizing healthcare data analyses and research monitoring and evaluating the work of plan administrators leading and developing procurement and contract documents and providing actionable insights for improvement. The ideal candidate will excel in directing and overseeing the work of diverse teams including internal staff consultants and vendors to ensure effective collaboration and successful project outcomes. This role requires strong analytical communication writing and project management skills and the ability to drive initiatives that enhance plan efficiency and performance.

This position is posted at two levels Health Insurance Data Analyst and Senior Health Insurance Data Analyst. Selected candidate will be offered the position that most closely matches their education and experience.

Salary range
Health Data Analyst : $73790 $92237 annually
Senior Health Data Analyst : $89286 $111608 annually

WHAT YOU WILL DO:

Health Insurance Data Analyst

Research and Data Analysis
Performs healthcare data analyses to support plan performance evaluations and identify key trends.
Develops SQL queries in the data warehouse to extract claim data for use in analyses and dashboards.
Assists in synthesizing data into clear and concise analyses and dashboards to inform decisionmaking and drive improvements.

Vendor Management
Reviews and validates routine vendor reports on health plan performance and ensure adherence to contractual obligations.
Solicits collects and reports on regular feedback from Health staff relating to vendor performance.
Addresses minor vendor performance issues with guidance from senior team members.
Assists in reconciling financial guarantees relating to medical loss ratios claim trends pharmacy rebates and discounts and ROIs.

Procurement and Contracting
Participates in market research and support procurement activities to assess and implement services.
Collaborates with internal stakeholders to draft sections of procurement documents and assist in their timely completion.
Drafts routine contract amendments and executive memos outlining contractual improvements under the guidance of senior team members.

Health Plan Management
Assists in developing recommendations for improving plan performance and cost containment.
Provides support for internal and external audits and track resolutions.
Tracks legislative bills and provide support for fiscal note analyses.
Participates in the development of department policies and procedures

Performs related work as assigned.

SeniorHealth Insurance Data Analyst

Research and Data Analysis
Conducts indepth research and analysis of health care data to evaluate plan performance identify trends and develop actionable insights.
Synthesizes data into clear and concise analyses to inform decisionmaking and drive improvements.
Utilizes data visualization tools and techniques to effectively present complex data to diverse audiences.
Develops and automates SQL queries in our internal data warehouse to extract claim data for use in analyses and dashboards.
Reviews reporting of health care data from external sources including from TRS health care consultants insurance companies or other industry resources.
Analyzes provider reimbursement levels highcost claims costs by geographic area and place of service and claim accuracy.
Identifies enrollment and cost trends costsaving opportunities and potential fraud waste and abuse.
Analyzes claim data to support invoice processing.

Vendor Management
Conducts regular assessments of vendor activities to evaluate performance based on good understanding of contracts and adherence to contractual obligations.
Reviews and validates vendor reports on health plan performance.
Reconciles financial guarantees relating to medical loss ratios claim trends pharmacy rebates and discounts and ROIs.
Directs the work of vendors and monitor their progress on enacting TRS initiatives and information requests.
Addresses and resolves noncompliance or subpar performance issues with vendors and escalates issues appropriately.
Leads meetings with vendors and manage agenda items.

Procurement and Contracting
Conducts market research to assess the products services and viability of companies that could potentially enhance TRS services.
Collaborates with internal stakeholders within the Health Purchasing and Legal & Compliance divisions as well as with consultants to develop technical requirements scopes of work evaluation criteria and procurement documents.
Acts as project manager to ensure procurement documents are produced timely and according to project workplans.
Negotiates contract renewal terms requirements and improvements.
Drafts businessneed based solicitation documents
Analyzes submissions/proposals from vendors and summarize responses.

Health Plan Management
Communicates with stakeholders related to plan performance and initiatives claims and utilization provider network updates pharmaceutical changes marketplace situations and trends.
Recommends and implements strategies to optimize benefit delivery plan performance cost containment and clinical outcomes.
Collaborates with internal and external auditors to conduct claim and vendor performance audits; track all audit findings through resolution.
Reviews legislative bills and provide fiscal note analyses. Implement bills that become law.
Supports the development of department policies and procedures.
Provides training to new team members and to the Health division.

Performs related work as assigned.

WHAT YOU WILL BRING:

Required Education
Bachelors degree from an accredited college or university in health information management health care administration public health statistics finance business or a closely related field.
High school diploma or equivalent and additional fulltime experience in health plan administration health data and/or health financial analysis claim auditing or similarly related experience may be substituted on an equivalent yearforyear basis.

Required Experience
Three 3 years of fulltime directly related progressively responsible experience in analyzing health care claims data health financial data administration of a health insurance plan or similarly related experience. (Analyst)
Five 5 years of fulltime directly related progressively responsible experience in analyzing and visualizing health care claims data health financial data administration of a health insurance plan or similarly related experience. (Senior)
A masters degree or doctoral degree in a directly related field may be substituted on an equivalent yearforyear basis.

Preferred Qualifications
Advanced degree in actuary science finance mathematics statistics business health care administrations or closely related field.
Recent experience in health plan administration or consulting pharmacy benefits actuarial services business finance claim auditing procurement and contracting.
CEBS Certification
CTCM Certification within 6 months of hire.

Knowledge of
Data analysis concepts and methods including education equivalent to at least statistics for business health benefit claims processing Medicare coordination of benefits standard medical procedures and billing.
Health care claims data including CPT HCPCS DRG ICD10 and NDC.
Health care related laws regulations policies and procedures.
Selffunded and fully insured group health benefit products and contracts including Medicare Advantage.
Provider networks contracts plan operations and systems.
Healthcare systems and clinical concepts.

Skill in
SQL to query data and other tools such as R or Python.
Researching compiling and analyzing complex data.
Managing projects including planning organizing and prioritizing work assignments to manage a highvolume workload in a fastpaced and changing environment.
Interpreting and applying complex laws regulations policies and procedures.
Completing detailed work with a high degree of accuracy.

Ability to
Meet frequent and multiple deadlines manage conflicting priorities and demands and adapt to changes in schedules and assignments.
Think critically analyze problems evaluate alternatives and proactively recommend effective solutions.
Communicate effectively and maintain harmonious working relationships with coworkers agency staff vendors and other external contacts and to work collaboratively in a professional team environment.