Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

1.    Analyzes large datasets to uncover trends, patterns, and insights related to healthcare claims, member behavior, utilization, costs, and other key performance metrics.
2.    Designs and develops comprehensive reports and dashboards using business intelligence tools (e.g., Tableau, Power BI) to communicate findings to key stakeholders.
3.    Performs statistical analysis and predictive modeling to inform business decisions, identify opportunities for cost savings, and improve outcomes.
4.    Presents actionable insights to senior management and cross-functional teams in a clear and concise manner.
5.    Monitors and ensures the accuracy, completeness, and timeliness of healthcare data used for analysis and reporting.
6.    Develops and implements data validation processes to ensure data integrity and reliability.
7.    Assists in the development of data governance standards and practices to support regulatory and compliance requirements.
8.    Works with various Alignment departments including Provider Contracting and Network Development staff to analyze contract rate trending impact and anomalies.
9.    Identify opportunities to improve data analysis processes, tools, and techniques to enhance productivity and accuracy.
10.    Stay current with industry trends, data analytics technologies, and healthcare regulations to continuously improve data-driven decision-making within the organization.
11.    Supports finance and operations in developing predictive KPI’s to better forecast and manage the business of Alignment. 
12.    Other projects and duties as assigned.

Supervisory Responsibilities:

• N/A

Job Requirements:

• Experience: Required: Minimum 3 years of experience as a Data Analyst. Two years of experience with statistical modeling, data mining, and predictive analytics techniques.• Preferred: Insurance and healthcare experience.
• Education: Required: High School Diploma or GED.  Bachelor's degree or four years additional experience in lieu of education.• Preferred: MBA
• Training:Specialized Skills:
• Required:
  • Knowledge of Access, SQL and/or other database programs
  • knowledge of healthcare data types, including claims, eligibility, medical records, and encounter data.
  • At least an intermediate level of proficiency with MS Excel (Pivot tables, VLOOKUP, etc.)
  • Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
  • Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
  • Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly
  • Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
  • Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
  • Report Analysis Skills:  Comprehend and analyze statistical reports.

Licensure:

• Required: None

Other:

• Knowledge of principles and practices of finance administration in accounting, budgeting, and auditing.
• Understanding of CMS Premium payment methodologies to MA Health Plans. Understanding MMR documentation, premium payment calculations, Risk adjustment Factors (RAF), other premium adjustments, and file layout.
• Understanding of CMS provider payment methodologies (DRG, RBRVS, etc.)
• Understanding of operations, services and activities within a Data Warehouse environment (Claim Data, Membership, Eligibility, and Revenue Data, etc.)
• Understanding provider capitation contracts, development of capitation rates, contract carve outs, performed comparative analysis to Fee For Service.
• Exposure and ability to use Actuarial studies related to IBNR and LDS.
• Understanding of provider contracts for medical groups, independent physicians, and hospitals.
• Understanding of payment methodologies for Hospitals (DRG, Per Diem, % of Billed, etc.) and Physicians (RBRVS, FFS, Capitation, etc.) and other ancillary providers.
• Develop new analysis and approaches to the use of data that allow fresh insights into the business of the company.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 While performing the duties of this job, the employee is regularly required to talk or hear.

2 The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

3 The employee frequently lifts and/or moves up to 10 pounds.

4 Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].