Come Grow With Us At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges. Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person – health, health care, and social services and supports – are met. We are seeking collaborators, innovators, and those who are driven to be their very best. If you are looking for a career of purpose and are passionate about having an impact on society’s health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.
About this role:
Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
**This position is open to California residents only**
ESSENTIAL FUNCTIONS
Job Function & Responsibilities
- Perform advanced statistical and quantitative analysis of healthcare, operational, claims, encounter, membership, and other enterprise data.
- Develop statistical models and algorithms to identify anomalies, patterns, trends, risks, and opportunities that support operational and strategic decision-making.
- Apply appropriate statistical methodologies including regression, hypothesis testing, forecasting, segmentation, outlier detection, trend analysis, and other quantitative techniques.
- Develop and maintain analytical solutions using SQL, Python, R, Power BI, and other approved analytical tools.
- Serve as the analytical owner or subject matter resource for assigned operational domains.
- Develop enterprise dashboards, reports, data visualizations, and analytical products that translate complex information into actionable business insights.
- Automate recurring analytical processes, regulatory metrics, operational KPIs, and data validation activities.
- Analyze large and complex datasets from multiple sources and identify relationships, trends, data-quality issues, and opportunities for improvement.
- Perform data profiling, validation, reconciliation, and quality analysis to ensure analytical outputs are accurate, complete, and appropriate for their intended use.
- Develop and maintain data models, analytical datasets, data definitions, and source-to-target mapping documentation.
- Partner with business stakeholders to define analytical questions, identify appropriate methodologies, establish measures of success, and translate findings into business recommendations.
- Collaborate with Information Technology, Enterprise Analytics, developers, data engineers, consultants, and other technical resources to improve enterprise data assets and analytical capabilities.
- Support development and enhancement of enterprise data warehouse solutions, including Microsoft Azure Synapse and other approved platforms.
- Develop analytical solutions supporting regulatory and operational functions including Grievances & Appeals, Encounters, Risk Adjustment, Claims, Membership, and related areas.
- Evaluate patterns and anomalies within claims and encounter data that may indicate operational issues, payment variation, data-quality concerns, or opportunities for further investigation.
- Develop methodologies to measure operational performance, identify statistically significant variation, and evaluate the effectiveness of operational interventions.
- Perform exploratory data analysis to identify opportunities for new analytical models, measures, and decision-support tools.
- Clearly document analytical methodologies, assumptions, limitations, data sources, and results.
- Present complex analytical findings to technical and non-technical audiences in a clear and actionable manner.
- Provide analytical guidance and technical support to Data Analyst I staff and other members of the Operations Analytics team as appropriate.
- Participate in cross-functional projects and enterprise initiatives requiring advanced analytical expertise.
- Maintain awareness of emerging analytical techniques and technologies and recommend opportunities to improve the department's analytical capabilities.
- Ensure analytical solutions meet business requirements, organizational standards, and applicable regulatory requirements.
- Provides subject matter expertise.Perform other duties as assigned.
MINIMUM QUALIFICATIONS
Education & Experience:
- Bachelor's degree in Statistics, Mathematics, Data Science, Computer Science, Economics, Information Systems, Business Analytics, or another quantitative or related field.
- Five plus (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.
- Makes informed decisions within scope of role.
Equivalent In lieu of degree: Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.
- Nine (9) or more years of progressively responsible experience performing data analysis, statistical analysis, business intelligence, or related analytical work
KNOWLEDGE, SKILLS & ABILITIES
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.
Technology & Software Skills:
Required
- Advanced SQL/T-SQL
- Relational databases
- Power BI or comparable data visualization platform
- Advanced Microsoft Office skills
Preferred:
- Python and/or R for statistical analysis and data manipulation
- Microsoft Azure
- Azure Synapse Analytics
- Databricks
- Git or other version-control tools
- Statistical modeling and machine-learning libraries
- Data warehouse and data modeling tools
Competency Statements:
- Advanced Analytical Skills – Ability to apply quantitative and statistical methods to complex business problems and develop meaningful conclusions from data.
- Statistical Reasoning – Ability to select appropriate analytical methodologies, evaluate statistical results, recognize limitations, and communicate findings accurately.
- Business Acumen – Ability to understand operational objectives and translate analytical findings into actionable business recommendations.
- Problem Solving – Ability to independently investigate complex problems, identify root causes, and develop data-driven solutions.
- Data Quality – Ability to assess the accuracy, completeness, consistency, and appropriateness of data used for analytical purposes.
- Systems Analysis – Ability to understand relationships among business processes, information systems, data structures, and analytical outputs.
- Decision Making – Ability to formulate sound recommendations using available quantitative and qualitative information.
- Strategic Thinking – Ability to identify how analytical capabilities can support long-term organizational and operational objectives.
- Communication, Oral – Ability to communicate complex analytical concepts effectively to technical and non-technical audiences.
- Communication, Written – Ability to document analytical methods, findings, assumptions, and recommendations clearly and concisely.
- Presentation Skills – Ability to effectively present analytical findings and recommendations to stakeholders and leadership.
- Relationship Building – Ability to establish effective partnerships with operational, technical, and analytical stakeholders.
- Collaboration – Ability to work effectively across departments and disciplines to solve complex business problems.
- Initiative – Ability to independently identify analytical opportunities and develop solutions with appropriate guidance.
- Time Management – Ability to prioritize and complete multiple analytical initiatives within established deadlines.
- Continuous Learning – Ability to remain current with evolving analytical methods, technologies, and industry practices.
The estimated pay range for the position is:
$100,000.00 - $150,000.00The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in. 7115000115000