Sr. Health Plan Operations Analyst

About the role

The Sr. Analyst, Health Plan Performance (HPP) Ops is responsible for extracting, analyzing, and transforming complex health plan data into actionable strategic insights. This role drives dashboard creation, leads rigorous quality assurance auditing, and provides cross-functional leadership and mentorship to optimize value-based care contract performance.

Primary Duties

Dashboard Creation & Analytical Design

Design, build and maintain dashboards, productivity trackers, and KPIs utilized by leadership to improve market performance and daily operations.

Build high-complexity queries of back-end data to power dashboards and custom ad-hoc projects.

Present data findings clearly through visualization tools to ensure understanding among diverse stakeholders and colleagues.

Incorporate industry benchmarks into visual metrics (charts, graphs, pivot tables) to show baseline and current states.

Identify, monitor, and communicate changes or trends in quality and spend metrics.

Auditing & Quality Assurance

Act as the first line of defense investigating, triaging, documenting, and resolving internal and external data quality issues.

Create and apply testing algorithms to evaluate large data streams throughout the system data flow.

Audit year-end performance and claims data for discrepancies, reporting errors to payer teams for swift resolution.

Day-to-Day Operations

Source, clean, and organize data from multiple streams (payer portals, Rx claims files, SFTP sites, and internal databases).

Execute advanced SQL queries in Snowflake to supplement payer data for analysis and reporting QA.

Develop complex formulas and templates in Google Sheets and Excel to streamline repetitive data tasks.

Maintain comprehensive documentation regarding operational analytics, source-of-truth architectures, and peer cross-coverage plans.

Leadership Support

Assist the manager with work coordination, mentoring junior analysts, developing training plans, and reviewing team work products.

Serve as a data subject matter expert (SME); attend meetings in the manager's absence.

Facilitate clear intradepartmental and cross-functional communication among key stakeholders.

Other duties as assigned

Minimum Qualifications

Bachelor’s degree in a related quantitative field or equivalent professional experience.

4+ years of experience with data management, analysis, QA, and auditing healthcare or payer data.

Intermediate SQL programming experience (Snowflake preferred).

Advanced Microsoft Excel / Google Sheets skills (complex formulas, nested functions, pivot tables).

Strong communication skills with the ability to collaborate effectively across remote teams.

Proactive mindset with a proven ability to prioritize multiple tasks in a fast-paced environment.

Preferred Qualifications

Understanding of value-based care/Alternative Payment Models, Medicare, and Non-MSSP quality measures

Experience with statistical software, such as R or Stata

Physical Requirements

Prolonged periods of sitting at a desk and working on a computer.

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The evidence behind this listing

Workplace

Remote Matched in posting text

Seniority

senior From the job title

Employment type

Not established

Location as listed

Remote, United States

Pay and work authorization

Stated pay

$66k–79k/yr Employer field

Visa sponsorship

Not stated

Security clearance

Not established

Citizenship

Not established