Senior Consultant, Data Analytics – Network Evaluation

Responsibilities

• Analyze complex healthcare data sets to identify trends, patterns, and insights.
• Create and present reports, dashboards, and visualizations to communicate findings to stakeholders.
• Isolate healthcare trend drivers and financial impacts associated with client medical claims, pharmacy claims, and other types of healthcare data.
• Perform varying types of analysis including medical carrier network valuations, discount analysis, and benchmarking.
• Leverage real-world, statistical data and modeling to recommend, test, validate, and track supporting health economics, return on investment (ROI), and healthcare benefit models for client businesses beyond traditional methods.
• Develop analytical analytics, data models, reporting, and data mining tools that scale across clients.
• Co‑develop and implement data collection strategies, design, and maintain databases.
• Conduct complex analyses adhering to best practice standards by selecting appropriate data sources, developing assumptions, recognizing considerations, and establishing recommendations.
• Collaborate with cross‑functional teams to define data requirements and ensure data accuracy and integrity.
• Identify opportunities for process improvement and efficiency through data analysis.
• Stay up‑to‑date with industry trends and best practices in data analysis.
• Resolve unreasonable results, suboptimal solutions, and data anomalies based on experience and professional judgment.
• Act as a technical expert and advise on strategic data mining techniques used to identify new relationships or patterns in data.
• Consult and provide expertise on new or enhanced product development opportunities including discussions on methodology, data requirements, coding implications, and the viability and profitability of a given proposal.
• Build predictive models to accurately analyze potential outcomes that are likely costs / savings for a given initiative or event(s).
• Develop and maintain effective cross‑functional working relationships to assure accurate, timely teamwork and project execution with assigned teams.
• Translate, document, and present approaches, processes, and results of complex modeling and statistical analysis into layperson terms for diverse, internal and external audiences.
• Build and maintain client relationships.
• Monitor market trends, engage in market research, and identify opportunities for initiatives.
• Support the development and training of team members and colleagues.
• Participate in peer review of your own work as well as your colleagues.
• Document all developed work with version controlling and logic documentation.

Requirements

• Bachelor’s degree (BS) in Mathematics, Actuarial Science, Statistics, Economics, or Computer Science.
• 7+ years’ working experience as an Actuarial Analyst, Data Analyst, or Data Scientist in the Health Care sector.
• 5+ years of hands‑on experience with structured query languages and statistical computing (e. g., R, RStudio, SQL, Python, SAS).
• 3+ years of hands‑on experience building and conducting ETL tasks.
• Knowledgeable about applied statistics, experimental design, and machine learning techniques.
• Expert with data mining and visualization tools such as Qlik, Tableau, or Power BI.
• Experience with developing medical and pharmacy utilization reporting, establishing utilization trends, and identifying meaningful and actionable observations.
• Experience with Uniform Discount and Data Specification (UDS) submissions is a plus.
• Experience with underwriting insurance premiums is a plus.
• Ability to generate information quickly and manage multiple projects at once.
• Knowledge of conducting health statistical modeling for medical and pharmacy, ROI analyses, and indirect comparisons and also hands on expertise with respect to newer and non‑traditional data science approaches.
• Diverse experience of healthcare databases and data sources (claims, encounters, labs, EMR, etc.).
• Extensive knowledge of healthcare/medical economics data such as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APC.
• Strong analytical skills with the ability to collect, organize, analyze, conceptualize, problem solve, and disseminate information confidently and collaboratively with attention to detail, accuracy, timeliness.
• Solid knowledge of business, financial, strategic concepts, and emerging trends.
• Solid interpersonal skills, oral and written, and a professional presence.
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