Sr. Analyst – Data & Analytics (Remote)

Role Summary

The Sr. Analyst – Data & Analytics is responsible for ensuring the accuracy, analysis, and interpretation of payer claims data to support performance tracking, utilization management, and value-based care initiatives. This is a hands-on individual contributor role requiring deep expertise in healthcare analytics and tools like MedeAnalytics.

Key Responsibilities

Claims Data Quality & Governance

• Lead quality assurance processes for medical and pharmacy claims data across eligibility, provider, diagnosis, procedure, and financial fields
• Detect, investigate, and resolve data inconsistencies (e.g., lag, duplication, missing or mis-coded claims)
• Collaborate with data engineering teams, vendors, and payers to address data issues
• Establish and maintain data validation rules, standards, and documentation

Analytics & Utilization Insights

• Analyze key utilization metrics such as inpatient admissions, ED visits, readmissions, PMPM cost trends, and length of stay
• Benchmark performance using national, regional, and risk-adjusted comparisons
• Perform cohort analysis, trend analysis, and pre/post evaluations
• Translate complex claims data into actionable insights for clinical and operational stakeholders

MedeAnalytics Platform Ownership

• Act as a primary user and subject matter expert for the MedeAnalytics platform
• Develop, validate, and maintain dashboards, reports, and analytical views
• Ensure consistency between platform outputs and internal data models
• Provide guidance on platform capabilities and best practices

Stakeholder Collaboration & Communication

• Partner cross-functionally with clinical, operations, finance, and growth teams
• Present insights and recommendations to senior leadership in a clear, concise manner

Required Qualifications

• 5–8 years of experience in healthcare analytics
• Strong background working with payer medical and pharmacy claims data
• Solid understanding of utilization metrics and healthcare cost drivers
• Hands-on experience with MedeAnalytics (required)
• Advanced SQL (and/or SAS) skills with experience in visualization tools (Power BI, Tableau, or similar)
• Demonstrated experience in QA of complex healthcare datasets
• Bachelor’s degree in Analytics, Statistics, Health Informatics, or a related field

Preferred Qualifications

• Experience supporting value-based care models (MA, D-SNP, ACO, etc.)
• Familiarity with HEDIS, Stars, or CMS reporting frameworks
• Experience with risk adjustment methodologies (HCCs)