Healthcare Statistical Analyst I/II/III/IV (VBP)

Role Description

The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department that support the Health Plans operations which monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. This role interacts with internal and external partners and Regulatory agencies. This role monitors trends, brings forward opportunities and insights found in the data to the applicable audiences. This position supports leadership by providing statistical information and analysis needed to make informed decisions, identifies trends, and utilizes data mining techniques and development of advanced predictive models.

Qualifications

• Bachelor’s Degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science or relevant field required.
• One (1) year of related experience preferred.
• Strong analytical skills, verbal and written communication skills.
• Strong interpersonal skills with demonstrated ability and willingness to collaborate with other team members.
• Ability to prioritize, multitask, and maintain multiple simultaneous projects.
• Intermediate technical skills including proficiency in Microsoft Office Suite.
• Programming skills in SQL, SAS, VBA, or similar programming language is preferred.
• Two (2) years related experience (Level II).
• A strong understanding of health insurance & health insurance products, managed care, accounting principles, the competitive market, the legislative environment, and any regulatory issue affecting the Health Plan (Level II).
• Ability to work independently, with high level of self-motivation to improve processes (Level II).
• Proficient programming skills in SQL, SAS, VBA, or similar programming language preferred (Level II).
• Four (4) years of related experience (Level III).
• Ability to perform complex modeling independently (Level III).
• Strong ability to recognize and automate repetitive tasks (Level III).
• Ability to communicate analytical findings at the appropriate level of detail for receiving audience (Level III).
• Demonstrated experience leading projects or process improvement initiatives (Level III).
• Six (6) years related experience (Level IV).
• Advanced understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials (Level IV).
• Advanced ability to independently communicate analytical findings at the appropriate level of detail for receiving audience (Level IV).
• Strong ability to independently write, communicate and present complex concepts to both actuarial and non-actuarial audiences (Level IV).

Requirements

• Updates existing and aids in the creation of new analysis pertaining to benefit designs, claims experience, Value Based Payment (VBP) programs and valuation of internal and externally led claims savings and risk adjustment initiatives.
• Maintains existing processes including but not limited to reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work. Creates and maintains appropriate documentation for work.
• Assists with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings.
• Compiles and analyzes data to draw conclusions, support data quality, and provide recommendations.
• Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
• Conducts analyses for and communicates with other departments on various initiatives (Level II).
• Assists the development of analyses concerning complex issues & trends, coordinates with staff (Level II).
• Participates in reviewing and evaluating emerging trends in healthcare, establishing reserves and producing financial analysis (Level II).
• Recommends appropriate applications and process changes to existing and new analysis (Level II).
• Reconciles Data Warehouse data with corporate financials or encounter submissions and identifies and develops corrective action with regards to Data Warehouse integrity issues (Level II).
• Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting (Level II).
• Independently ideates process improvements and recommends changes in process to direct leadership (Level II).
• Creates and maintains documentation related to data analysis, data models, and data mapping which includes creating technical documentation, process documentation and training materials (Level II).
• Draws together facts and input from a variety of data sources (Level II).
• Reviews and ensures pricings are consistent with established profitability targets for relevant business segments (Level III).
• Researches and analyzes data across complex data ecosystem including operational and analytical data platforms to develop insightful and effective reporting and dashboards (Level III).
• Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems (Level III).
• Develops analyses concerning complex issues and trends, coordinating with several different disciplines and staff (Level III).
• Leads and supports departmental projects (Level III).
• Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy (Level III).
• Recommends departmental annual performance goals (Level IV).
• Offers strategic recommendations on the analysis of data, data collection, and integration using the knowledge of best practices and business requirements (Level IV).
• Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques (Level IV).
• Represents the Department on special projects involving other areas of the company or external constituents (Level IV).
• Partners and leads projects including stakeholders from a variety of departments (Level IV).
• Interprets how regulatory changes affect Health Plan and develops impact analyses (Level IV).
• Collaborates with senior leadership in meeting corporate goals and strategic decision making (Level IV).

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Compensation Range(s)

• Level I: Grade E1: Minimum $62,400 - Maximum $84,000
• Level II: Grade E3: Minimum $62,400 - Maximum $106,929
• Level III: Grade E5: Minimum $71,880 - Maximum $129,384
• Level IV: Grade E6: Minimum $79,068 - Maximum $142,322