Data Analyst - Health, Senior

Job Description

Your Role

The Healthcare Quality and Affordability (HQA) division is responsible for developing analytics and supporting materials to assist and guide strategic development and maintenance of the Blue Shield of California (BSC) network of physicians, hospitals, ambulatory surgery centers, HMO IPA's, and medical groups. Our team, Network Performance Analysis and Contracts (NPAC) is part of the HQA division and focuses on provider network performance analysis, reporting, and consulting.

The Data Analyst - Health, Senior will report to the Manager, Provider Services - Network. In this role you will provide analysis and consultative services across network design, contracting, pricing activities and product planning in alignment with the corporate and network strategy roadmaps. Additionally, you will manage and oversee development and production of regulatory network filing artifacts as required by regulators for all BSC and Promise Health Plan Commercial, Medi-Cal, and Medicare networks. This role delivers network analytics, reporting and oversight on existing networks to ensure meeting regulatory access and availability standards.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work
In this role, you will:

• Develop and conduct evaluations and studies within limited time frames and produce analyses that are easy for non-technical persons to understand
• Interact with internal and external customers to define complex reporting needs and specifications; design and implement complex report programming according to specifications
• Present effectively to internal and external customers on analytics/reports/presentations that are critical for their business continuity and decision making
• Participate in internal and external task forces and committees to provide analytical insights and support for implementation of new programs, applications, products and services and enhancement of existing applications/systems
• Independently summarize findings and present data in formats such as Excel pivots, PowerPoint, reports, grids and tables
• Lead and manage projects that may involve coordinating a team and working with different stakeholders
• Manage creation, collection, tracking, and compilation of evidence from internal teams into regulator reports
• Analyze data using a variety of software, provide recommendations based on the results, and present to internal stakeholders
• Adapt to and incorporate state and federal regulatory updates into existing policies, procedures, and assessments
• Maintain and enhance Behavioral Health (BH) network analytics models and tools to support regulatory filings and strategic analyses, ensuring data accuracy and reliability
• Conduct BH network adequacy analyses (time/distance, ratios, access gap identification) and provide insights that guide contracting, network design, and compliance decisions
• Prepare and validate BH data for regulatory submissions, including DHCS, DMHC, CMS, CDI and NCQA required reporting/filings
• Develop dashboards and deliver executive-level insights on BH access, capacity, utilization, claims trends, grievances, and operational stability, supporting governance committees and leadership

Qualifications

Your Knowledge and Experience

• Requires an MPH, MBA, MS, MA in science, social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
• Requires 5 years of experience in Health Care (managed care, academic, or government payer)
• Intermediate to Advanced knowledge of MS Excel (able to model, use formula), Access (link tables, run queries)
• Experience with SQL/PL-SQL, SAS is preferred
• Good business acumen, ability to work in a team environment
• Good math, analytical and problem-solving skills
• Excellent communication (written and verbal) and presentation skills, previous experience in presenting to leaders
• Strong analytical and problem-solving skills
• Strong presentation skills
• Ability to work independently, proactively, and with little direction

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.