Data Analyst, Quality & Business Performance

We are seeking a Data Analyst Quality & Business Performance to join our Operational Performance Team. This isnt your typical report-pulling role; we need a systems thinker who can dive into scrappy healthcare data and use Statistical Process Control (SPC) to tell the story of our claims operations.

You will be responsible for distinguishing noise from signals helping us understand whether a spike in denials is a random fluke or a process shift that requires immediate intervention. If you have a passion for Lean Six Sigma principles and a deep understanding of the healthcare claims lifecycle we want to talk to you.

What You Will Do

• Analyze Claims Outcomes: Monitor denials approvals and partial approvals using industry-standard SPC and control charting.
• Signal Detection: Distinguish normal variation from data shifts that signal a need for process review.
• Data Transformation: Take raw unpolished extracts and transform them into meaningful control charts and actionable insights.
• System Design: Assist in designing and implementing healthcare IT solutions to ensure they meet both business needs and strict regulatory requirements.
• Stakeholder Communication: Present findings with a focus on interpretation over polish. We value the so what behind the data more than a pretty slide deck.
• Continuous Improvement: Stay current on SPC signal rules (trends/shifts/out-of-control) and apply them to improve validation workflows.

You Will Be Successful If...

• You exhibit systems thinkingyou dont just see a data point; you see the process that created it.
• You are detail-oriented and enjoy the hunt within large complex datasets.
• You can explain the difference between a trend and a shift to non-technical stakeholders.

What You Will Bring

Required Experience:

• Industry: 3-5 years in a health plan healthcare services company or closely related field.
• Domain Expertise: 3 years in healthcare operations (Authorizations or Claims) with a focus on quality/performance.
• Technical Mastery: * Expert Excel Skills: Must be proficient in Power Query Pivot Tables and advanced formulas.
  • Statistical Proficiency: Demonstrated ability to apply Standard Deviation and Control Charting to operational outcomes.
• Education: Bachelors degree in Health Informatics Business or a related field (or 7 years of direct experience).
• Residency: Must be a US Citizen or Green Card holder located on the East Coast.

Preferred:

• Hands-on SQL experience for data extraction and transformation.
• A background in Lean Six Sigma or quality improvement analytics.
• Experience with claims editing or payment integrity concepts.
• Masters degree in Health Informatics or Healthcare Administration.