Enterprise Data Analyst III

Job Summary

The Enterprise Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs.

The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff. 

Duties

Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights.

Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance.

Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows.

Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards.

Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.

Maintains awareness of data lineage and governance compliance throughout all analytic work.

Manages project planning, tracking, and post-implementation assessment for assigned deliverables.

Mentors and models adherence to analytic development best practices.

Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

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.

Preferred Certification: AAPC Certified Risk Adjustment Coder (CRC®); Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™); NAMAS Certified HCC Coder (CHCC™); AHIMA Certified Coding Specialist (CCS®)

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 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health.

Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights.

Experience analyzing multiple data sources and translate findings into actionable recommendations.

Preferred:

Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling.

Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis.

Experience mentoring junior analysts or providing guidance on analytic best practices.

Skills

Required

Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes supporting enterprise dashboards, reports, and analytic deliverables. Advanced proficiency in Tableau (or equivalent BI tools) to design, optimize, and automate dashboards and visualizations for enterprise level insights.Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance.Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices.Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring. Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control. Ability to translate complex business problems into structured analytic requirements and actionable insights. Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals. Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains. Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs. Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment. Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment. Ability to mentor junior analysts and promote adherence to analytic best practices. Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately. Ability to communicate findings effectively to both technical and non-technical stakeholders. 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

General Skills Preferred: Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management

Domain Specific Experience and Skills:
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.

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.

Preferred Certification: Certified Professional in Healthcare Quality (CPHQ)

Physical Requirements

Additional Information

Domain Specific Experience and Skills:

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 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. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains. 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.

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

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.