Operations Data Analyst

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

POSITION SUMMARY

Under general supervision, the Operations Data Analyst is responsible for supporting the operations department by conducting specific and comprehensive analysis of a wide range of data and processes.  This role is also responsible for implementing data models and relational database definitions across multiple computing environments to support the business needs and requirements for Gold Coast Health Plan operations department.  This position is also responsible for developing internal reports and exception reporting to ensure routine, timely and accurate claims adjudication, QA and membership reporting.  This position will interact with various departments to ensure appropriate data is developed, maintained and used appropriately throughout Gold Coast Health Plan. 

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

•    Identify, analyze, and interpret trends, patterns and/or data for methods to better benefit the Plan or membership.

•    Develop, maintain and enhance reports necessary for operations department functions.

•    Use table and systems such as HSP to pull and analyze data.

•    Develop graphs, reports, and presentations for operations reporting.

•    Perform basic statistical analyses for operations department.

•    Extract and analyze data from various sources to achieve cost saving programs for the Plan.

•    Perform membership analysis, trending reports and enrollment data.

•    Call Center statistics as related to how they impact member satisfaction and Call Center performance.

•    Provides accurate information about eligibility, benefits, and claim status and authorization requirements to service members.

•    Maintains an up-to-date and thorough knowledge of Gold Coast Health Plan's policies as related to eligibility and benefits.

•    Provides accurate research to resolve issues regarding eligibility and benefits, claims processing and operational oversight using appropriate systems.

•    Properly document as required by department standards in a clear and concise manner.

•    Perform other duties as assigned.

POSITION QUALIFICATIONS

Competency Statements

•    Analytical Skills - Ability to use thinking and reasoning to solve a problem.

•    Systems Analysis - Ability to determine how a system should work and how changes in conditions, operations, and the environment will affect outcomes.

•    Strategic Planning - Ability to develop a vision for the future and create a culture in which the long range goals can be achieved.

•    Communication, Written - Ability to communicate in writing clearly and concisely.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

•    Time Management - Ability to utilize the available time to organize and complete work within given deadlines. 

SKILLS & ABILITIES

Education: Bachelor’s Degree (four year college or technical school) Preferred, Field of Study: Information Management, Healthcare Information, Computing, Mathematics, Statistics, or related field. 

Experience:       

•    1 plus years of experience in data analysis in a managed health care 

•    Medi-Cal/Medicaid managed care experience strongly desired.

•    Any combination of experience and training that would provide the required knowledge, skills, and abilities would be qualifying.

•    Prior experience with Meditrac claims processing system: strongly desired

Computer Skills: Computer proficiency included in the MS Office programs, SQL Required.

Other Requirements: 

•    Adept at queries and report writing

•    Knowledge of and ability to analyze and present statistical data

•    Excellent analytical ability, judgment and problem solving

•    Ability to present complex information in an understandable and compelling manner

•    Communicate effectively and clearly in both verbal and written form

•    Ability to work independently and in a team setting