Data Analyst III – Medical Economics

• Interpret and analyze data from multiple sources (claims, provider, member, encounters).

• Develop, maintain, and troubleshoot complex SQL scripts, Excel models, and reports.

• Contribute to large-scale project planning and execution with limited direction.

• Design, test, and implement process enhancements; identify automation opportunities.

• Perform root-cause analysis of data irregularities and present findings/solutions.

• Manage multiple tasks and data review processes under tight timelines.

• Apply expertise in quantitative analysis, data mining, and visualization.

• Communicate insights effectively to non-technical stakeholders.

• Gather requirements, validate results, and present recommendations.

• Provide technical guidance to junior analysts.

Must-Have Qualifications

• Education: Bachelor’s in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance, or related field (Master’s preferred).

• Experience: 4+ years with large databases, data verification, and management (or 2+ years IT). Healthcare analytics strongly preferred.

• Technical Skills:

  • SQL (complex queries, SELECT statements, multiple JOINs).

  • Advanced Excel (Pivot Tables, Power Query, VLOOKUP/XLOOKUP, nested formulas, financial modeling).

  • Power BI (DAX, Power Pivot).

• Domain Knowledge: Medicare, Medicaid, Marketplace analytics; reimbursement methodologies (DRG, APC, EAPG).

• Financial Analytics: MLR targets, ROI evaluation, contract/network analysis.

Preferred Skills

• Python and R for advanced analytics.

• Statistical/data mining techniques (trend analysis, modeling).

• Familiarity with claims payment, utilization management, risk adjustment.

• Actuarial/financial experience in healthcare settings.