Job Description
Must Have Technical/Functional Skill
We are looking for an experienced Healthcare Domain Subject Matter Expert (SME) who has extensive knowledge of MedEcon, Milliman MedInsight (Claims Analytics Platform), and a strong grasp of Value-Based Care (VBC) models. The successful candidate will function as a key contributor, providing analytical support for complex healthcare datasets, deriving actionable insights, and addressing operational requests related to reporting and claims analysis.
The ideal candidate is hands-on, analytical, and thrives in fast-paced environments, particularly with tools and platforms such as Databricks, PowerBI, and various healthcare data sources.
Must Have Technical/Functional Skills
• Domain Expertise:
• In-depth experience in the healthcare domain, focusing on claims data and healthcare operations.
• Knowledge of provider reimbursement models and performance/quality reporting.
• Strong understanding of Value-Based Care (VBC) concepts and performance measurements.
• Proficient in Milliman MedInsight (Claims Analytics Platform).
• Technical & Analytical Skills:
• Exceptional analytical and problem-solving abilities to work with large, complex datasets.
• Capability to analyze intricate, multi-source healthcare data and translate findings into understandable business insights.
• Strong critical thinking skills, focusing on crucial questions to guide business stakeholders.
• Hands-on expertise in a Databricks environment, including SQL, notebooks, and data exploration.
• Solid SQL skills for querying, validating, and analyzing healthcare data.
• Experience in supporting ad-hoc analytical and reporting requests.
• Tools & Platforms:
• Experience with ServiceNow for ticket management, triage, and incident resolution.
• Familiarity with healthcare data platforms, data warehouses, and reporting tools (Power BI) is preferred.
Preferred Qualifications
• Previous experience supporting payer, provider, or population health analytics teams.
• Exposure to quality, cost-of-care, utilization, or risk adjustment analytics.
Roles & Responsibilities
Business & Functional Analysis:
• Act as a subject matter expert in healthcare analytics, focusing on Value-Based Care models (such as shared savings, capitation, and quality measures).
• Convert business requirements into clear functional specifications and analytical solutions.
• Collaborate with business stakeholders, clinical teams, and technical teams to ensure data outputs align with business needs.
• Evaluate healthcare trends across claims, member, and provider data to support performance reviews and operational decisions.
• Provide insights into healthcare metrics like utilization, cost drivers, quality performance, and provider/member behavior.
Data Analysis & Reporting:
• Conduct complex data analyses using multiple healthcare sources, including claims (medical, pharmacy), eligibility and enrollment data, provider and member data, and quality performance metrics.
• Design and deliver ad-hoc and recurring reports utilizing Databricks and related analytics tools.
• Validate data accuracy, identify trends, anomalies, and performance gaps, while effectively communicating insights.
Operational Support & Issue Triage:
• Respond to ServiceNow tickets, carrying out triage, impact analysis, root-cause assessments, and issue resolution for data and reporting matters.
• Assist with claims-related inquiries, including data discrepancies investigation, processing issues, and business-rule validation.
• Ensure the timely closure of tickets with comprehensive documentation and communication to stakeholders.
Stakeholder Collaboration:
• Serve as a trusted analyst for business users, advocating for data-driven decision-making.
• Effectively explain analytical findings to both technical and non-technical audiences.
• Offer recommendations based on data insights to enhance operational, clinical, or financial outcomes.
We are looking for an experienced Healthcare Domain Subject Matter Expert (SME) who has extensive knowledge of MedEcon, Milliman MedInsight (Claims Analytics Platform), and a strong grasp of Value-Based Care (VBC) models. The successful candidate will function as a key contributor, providing analytical support for complex healthcare datasets, deriving actionable insights, and addressing operational requests related to reporting and claims analysis.
The ideal candidate is hands-on, analytical, and thrives in fast-paced environments, particularly with tools and platforms such as Databricks, PowerBI, and various healthcare data sources.
Must Have Technical/Functional Skills
• Domain Expertise:
• In-depth experience in the healthcare domain, focusing on claims data and healthcare operations.
• Knowledge of provider reimbursement models and performance/quality reporting.
• Strong understanding of Value-Based Care (VBC) concepts and performance measurements.
• Proficient in Milliman MedInsight (Claims Analytics Platform).
• Technical & Analytical Skills:
• Exceptional analytical and problem-solving abilities to work with large, complex datasets.
• Capability to analyze intricate, multi-source healthcare data and translate findings into understandable business insights.
• Strong critical thinking skills, focusing on crucial questions to guide business stakeholders.
• Hands-on expertise in a Databricks environment, including SQL, notebooks, and data exploration.
• Solid SQL skills for querying, validating, and analyzing healthcare data.
• Experience in supporting ad-hoc analytical and reporting requests.
• Tools & Platforms:
• Experience with ServiceNow for ticket management, triage, and incident resolution.
• Familiarity with healthcare data platforms, data warehouses, and reporting tools (Power BI) is preferred.
Preferred Qualifications
• Previous experience supporting payer, provider, or population health analytics teams.
• Exposure to quality, cost-of-care, utilization, or risk adjustment analytics.
Roles & Responsibilities
Business & Functional Analysis:
• Act as a subject matter expert in healthcare analytics, focusing on Value-Based Care models (such as shared savings, capitation, and quality measures).
• Convert business requirements into clear functional specifications and analytical solutions.
• Collaborate with business stakeholders, clinical teams, and technical teams to ensure data outputs align with business needs.
• Evaluate healthcare trends across claims, member, and provider data to support performance reviews and operational decisions.
• Provide insights into healthcare metrics like utilization, cost drivers, quality performance, and provider/member behavior.
Data Analysis & Reporting:
• Conduct complex data analyses using multiple healthcare sources, including claims (medical, pharmacy), eligibility and enrollment data, provider and member data, and quality performance metrics.
• Design and deliver ad-hoc and recurring reports utilizing Databricks and related analytics tools.
• Validate data accuracy, identify trends, anomalies, and performance gaps, while effectively communicating insights.
Operational Support & Issue Triage:
• Respond to ServiceNow tickets, carrying out triage, impact analysis, root-cause assessments, and issue resolution for data and reporting matters.
• Assist with claims-related inquiries, including data discrepancies investigation, processing issues, and business-rule validation.
• Ensure the timely closure of tickets with comprehensive documentation and communication to stakeholders.
Stakeholder Collaboration:
• Serve as a trusted analyst for business users, advocating for data-driven decision-making.
• Effectively explain analytical findings to both technical and non-technical audiences.
• Offer recommendations based on data insights to enhance operational, clinical, or financial outcomes.
💡 Quick Summary
Seeking a career-building opportunity? The Healthcare Domain Subject Matter Expert Data Analyst position is now open for candidates interested in the MIS Executive sector. This role in Los Angeles offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in MIS Executive is a plus.
