Authorization and Claims Analytics Data Analyst III

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Authorization and Claims Analytics Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs. The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff. Duties Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights. Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance. Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows. Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards. Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases. Maintains awareness of data lineage and governance compliance throughout all analytic work. Manages project planning, tracking, and post-implementation assessment for assigned deliverables. Mentors and models adherence to analytic development best practices. Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. Perform other duties as assigned.Duties Continued Education Required Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred Master's DegreeExperience Required: At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health. Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights. Experience analyzing multiple data sources and translating findings into actionable recommendations. Experience with Utilization Management (UM) authorization workflows and prior authorization metrics. Preferred: Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling. Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis. Experience mentoring junior analysts or providing guidance on analytic best practices.Skills Required: Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes supporting enterprise dashboards, reports, and analytic deliverables. Advanced proficiency in Tableau (or equivalent BI tools) to design, optimize, and automate dashboards and visualizations for enterprise level insights. Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance. Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices. Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring. Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control. Ability to translate complex business problems into structured analytic requirements and actionable insights. Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals. Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains. Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs. Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment. Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment. Ability to mentor junior analysts and promote adherence to analytic best practices. Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately. Ability to communicate findings effectively to both technical and non-technical stakeholders. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution. Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams. Ability to analyze operational Key Performance Indicators (KPIs) (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Preferred: Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.Licenses/Certifications Required Licenses/Certifications Preferred Tableau Certified Data Analyst or Tableau Desktop SpecialistMicrosoft Certified: Power BI Data Analyst AssociateSnowflake SnowPro Core CertificationSnowPro® Specialty: Snowpark CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.Required Training Physical Requirements LightAdditional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)