Vālenz® Health

Healthcare Data Analyst – Claims, Quality and Provider Performance

Vālenz® Health

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Job Level

Mid-LevelSenior

Tech Stack

PythonSQL

About the role

  • Work hands-on with large, complex healthcare claims and provider datasets to ensure data accuracy and integrity
  • Utilize reference data sources and advanced validation techniques to ensure accuracy, completeness, and integrity of healthcare claims data
  • Assess provider scoring methodologies, identify discrepancies, and develop insights to optimize coverage accuracy
  • Design, develop, and maintain retrospective models for historical performance analysis, and predictive models to identify high-risk patients and prioritize actionable interventions
  • Translate complex analytical findings into clear, actionable insights, and effectively communicate results and recommendations to internal stakeholders and external clients
  • Aggregate and reconcile multiple data sources, applying statistical and computational methods to verify data integrity, identify anomalies, and implement necessary corrections
  • Execute comprehensive data analysis workflows, evaluate outcomes, and implement enhancements to improve model accuracy and data reliability
  • Review and optimize claim-matching processes, troubleshoot inconsistencies, and resolve data discrepancies to maintain high-quality outputs
  • Investigate data quality issues, conduct root cause analysis, document findings, and deliver actionable recommendations for process improvements
  • Collaborate with cross-functional teams to enhance analytical tools, refine methodologies, and implement scalable solutions that improve efficiency and analytical capabilities
  • Identify and resolve data issues using SQL and Python, apply statistical methods, and deliver clear, actionable insights to support decision-making across the organization

Requirements

  • Bachelor’s degree in a quantitative field (e.g., Statistics, Mathematics, Engineering, Computer Science, Finance, or Economics) or equivalent professional experience
  • Five (5) or more years of experience analyzing healthcare claims data, including complex and imperfect datasets
  • Strong analytical, problem-solving, and critical-thinking skills with proven ability to uncover root causes
  • Proficiency in SQL for querying and manipulating data; familiarity with Python or similar data tools preferred
  • Advanced Excel skills, including PivotTables and complex formulas, for data modeling and reporting
  • Knowledge of healthcare network rosters, provider data, and quality measurement methodologies
  • Exceptional attention to detail with a commitment to accuracy, data validation, and quality assurance
  • Highly organized and self-motivated, with the ability to manage multiple priorities independently while collaborating effectively with others
  • Master’s degree preferred
  • You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA
  • Quiet workspace free from distractions and reliable internet connection
  • Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software