Operations Data Analyst II

Gold Coast Health Plan is seeking an Operations Data Analyst II to support healthcare and operational decision-making through advanced quantitative analysis. In this onsite California role, you will build analytical models, dashboards, and automated processes, while partnering across business and technical teams to strengthen enterprise analytics and data warehouse capabilities. What you’ll do Perform advanced statistical and quantitative analysis across healthcare and enterprise data, including claims, encounters, membership, and operational datasets. Develop statistical models and algorithms to surface anomalies, patterns, trends, risks, and opportunities that inform operational and strategic decisions. Apply quantitative methods such as regression, hypothesis testing, forecasting, segmentation, outlier detection, and trend analysis. Build and maintain analytical solutions using SQL, Python, R, Power BI , and other approved analytical tools. Own analytical domains as a subject matter resource, including translating analytical findings into actionable business insights. Create and maintain enterprise dashboards, reports, data visualizations, and other analytical products. Automate recurring analytical workflows, including regulatory metrics, operational KPIs, and data validation activities. Analyze large, complex datasets from multiple sources to identify relationships, trends, data-quality issues, and improvement opportunities. Conduct data profiling, validation, reconciliation, and quality analysis to ensure analytical outputs are accurate and appropriate for intended use. Maintain data models and analytical datasets, including data definitions and source-to-target mapping documentation. Partner with stakeholders to define analytical questions, select methodologies, define success measures, and develop business recommendations. Collaborate with IT, Enterprise Analytics, developers, data engineers, consultants, and other technical resources to improve enterprise data assets and analytics capabilities. Support and enhance enterprise data warehouse solutions, including Microsoft Azure Synapse and other approved platforms. Develop solutions for regulatory and operational functions such as Grievances & Appeals, Encounters, Risk Adjustment, Claims, and Membership . Evaluate patterns and anomalies in claims and encounter data that may indicate operational issues, payment variation, data-quality concerns, or investigation needs. Develop methodologies to measure operational performance, identify statistically significant variation, and evaluate intervention effectiveness. Perform exploratory data analysis to identify opportunities for new analytical models, measures, and decision-support tools. Document analytical methodologies, assumptions, limitations, data sources, and results. Present complex analytical findings to technical and non-technical audiences. Provide analytical guidance and technical support to Data Analyst I staff and others on the Operations Analytics team as appropriate. Participate in cross-functional projects and enterprise initiatives requiring advanced analytical expertise. Stay current on emerging analytical techniques and technologies and recommend improvements to departmental capabilities. Ensure analytical solutions meet business requirements, organizational standards, and applicable regulatory requirements. Perform other duties as assigned. Required qualifications Bachelor’s degree in Statistics, Mathematics, Data Science, Computer Science, Economics, Information Systems, Business Analytics, or another quantitative or related field. Five (5) or more years of progressively responsible experience performing data analysis, statistical analysis, business intelligence, or related analytical work. Demonstrated experience writing complex SQL queries and working with relational databases. Demonstrated experience developing reports, dashboards, or analytical solutions using Power BI or another data visualization platform. Experience applying statistical methods to business or operational problems. Ability to make informed decisions within the scope of the role. Equivalent alternative to degree: will accept a combination of academic education, professional training, and work experience that demonstrates the ability to perform the duties. Nine (9) or more years of progressively responsible experience performing data analysis, statistical analysis, business intelligence, or related analytical work. Advanced SQL/T-SQL Knowledge of relational databases Power BI or comparable data visualization platform Advanced Microsoft Office skills Preferred qualifications Master’s degree in Statistics, Data Science, Mathematics, Economics, Analytics, Computer Science, or another quantitative field. Healthcare or managed care analytics experience. Medi-Cal/Medicaid or Medicare managed care experience. Experience analyzing healthcare claims, encounters, membership, eligibility, or risk adjustment data. Experience developing statistical models using large and complex datasets. Experience with anomaly detection, predictive modeling, forecasting, regression analysis, hypothesis testing, or other applied statistical techniques. Experience developing automated analytical workflows. Experience working with enterprise data warehouses and cloud-based analytical platforms. Experience communicating analytical findings and recommendations to business leaders and executive audiences. Knowledge of healthcare regulatory reporting and data-quality requirements. Tools and technologies SQL, Python, R, Power BI, T-SQL, Microsoft Office Microsoft Azure Synapse (including Azure Synapse Analytics) Databricks Estimated pay range USD 100,000 - 150,000 per year (California range) #J-18808-Ljbffr DataJobs