Enterprise Data Analyst II

Job Summary

The Enteprise Data Analyst II collaborates and contributes in the design, development, and delivery of analytic solutions that inform operational, quality, and financial performance across the organization. This focuses on transforming business questions into structured, validated, and well-communicated analytic outputs using approved enterprise data assets and governance standards.

The Enterprise Data Analyst II contributes to every stage of the analytics lifecycle from intake through code development, peer review, and ongoing maintenance and plays a key role in ensuring data accuracy and consistency across recurring enterprise reports and dashboards.

Duties

Translate defined business questions into structured analytic requirements and specifications.

Participate in structured requirements elicitation, documentation, and verification.

Develop and automate recurring reports and dashboards, applying standardized definitions and refresh cycles (daily, weekly, monthly, quarterly).

Validate data integrity and ensure compliance with data lineage and governance standards.

Contribute to analytic code review and continuous integration processes to maintain transparency, version control, and quality.

Collaborate with IT, business partners, and fellow analysts to resolve data issues and confirm analytic accuracy.

Apply foundational statistical methods (e.g., control charts, variance analysis) to interpret patterns in performance.

Participate in project tracking and post-implementation review to ensure solutions deliver measurable business value.

Perform other duties as assigned.

Duties Continued

Domain Specific Experience and Skills:

Domain Focus: Authorization & Claims Operations Analytics

Required: Experience with Utilization Management (UM) authorization workflows and prior authorization metrics. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution. Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams. Ability to analyze operational Key Performance Indicators (KPIs) (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.

Domain Focus: Network Strategy Analytics

Required: Experience supporting initiatives to optimize cost, access, and quality within provider networks. Experience analyzing provider networks, including contracting, credentialing, and panel optimization. Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.

Domain Focus: Risk Adjustment Analytics

Required: Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring. Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores. Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines). Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations.
 

Domain Focus: Medical Cost Driver Analytics

Required: Experience analyzing medical cost drivers across populations, conditions, and service types. Experience developing dashboards or analytic tools to monitor and optimize medical spend. Knowledge of claims, provider, and condition level analyses to support financial and operational decision-making. Ability to identify high-cost services, utilization patterns, and opportunities for cost containment.

Education Required

Education Preferred

Experience

Required:

At least 3 years of experience in analytics, data management, or reporting, preferably within healthcare, managed care, or a related industry.

Hands-on experience with SQL, reporting tools (Tableau, Power BI), and operational dashboards.

Experience in one or more domains (Authorization & Claims, Population Health, Quality, etc.) at a functional or project level.

Preferred:

Experience in health plan operations or managed care analytics.

Experience participating in enterprise reporting or dashboard projects with governance standards.

Skills

Required:

Proficient in SQL for complex exploratory analysis and foundational Extract, Transform, and Load (ETL) work to support dashboards, reports, and analytic deliverables.

Working knowledge of Tableau for building standard visualizations and dashboards.

Knowledge of version control tools (e.g., Git, GitHub) and collaborative development workflows. Implement and maintain version control, peer review (pull request), and continuous integration practices for analytic codebases.

Ability to conduct analyses to identify trends, patterns, and opportunities across organizational data.

Ability to translate business questions into structured requirements and actionable insights.

Ability to apply descriptive statistics and basic trend analysis to support operational decision-making.

Knowledge of general operations and performance drivers in a complex, data driven organization.

Ability to use Jira or Atlassian tools for task tracking and coordination within analytics projects.

Ability to communicate findings effectively to business partners with varying technical backgrounds.

Ability to work on multiple assignments simultaneously, prioritize tasks and know when to escalate issues.

Ability to work under challenging deadlines.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Domain Specific Experience and Skills:

Domain Focus: Member Experience Analytics

Required: Experience analyzing call center operations, enrollment services, and appeals & grievances.

Experience translating data into actionable insights to improve member experience and member engagement operations. Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools.  Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.
Domain Focus: Population Health Analytics

Required: Experience analyzing community supports, care management, health education, Managed Long-Term Support Services (MLTSS), and intervention programs. Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs. Knowledge of population health management frameworks and social determinants of health.  Ability to evaluate population level outcomes and operational performance metrics.
Preferred:  Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM.
 

Physical Requirements

Additional Information

Domain Specific Experience and Skills:

Domain Focus: Quality Improvement Analytics

Required: Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains. Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies. Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.

Preferred: Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS). Experience supporting provider focused incentive program analytics.

Domain Focus: Access to Care Analytics

Required: Experience analyzing appointment timeliness, access, and provider availability. Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling. Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring.  Knowledge of access measurement frameworks and regulatory requirements. Ability to evaluate member access metrics, network capacity, and operational performance.

Domain Focus: Enterprise Support Analytics

Required: Experience supporting enterprise-level KPI maintenance, cross-domain dashboards, and measure ROI analyses. Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring. Knowledge of analytics frameworks, governance standards, and enterprise reporting processes. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains.

Preferred:  Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.