7 – 10 years as a business or operations analyst working in a health plan IT or operational environment.
Undergraduate degree in Data Analytics, Information Systems, Computer Science, Health Informatics, Public Health, or a related field. Equivalent experience in healthcare data analysis, reporting, or business intelligence may be considered in lieu of a formal degree
Experience working with healthcare data in a data warehousing or analytics environment
Background in Utilization Management (UM), medical management systems, or prior authorization workflows.
Understanding of Medicare, Medicaid, and commercial insurance programs, including variations in coverage types (Group, Individual, ASO/Fully Insured, HMO/PPO).
Proven experience facilitating stakeholder and client meetings to gather, validate, and prioritize reporting and data requirements.
Demonstrated ability to document business and technical requirements, and collaborate with developers or data engineers to translate them into system or reporting functionality.
Hands-on experience with data validation, QA/testing, and troubleshooting within analytic or reporting pipelines.
Familiarity with Agile methodologies, SDLC processes, and tools such as JIRA and Confluence.
Strong proficiency in SQL and understanding of database structures, joins, and performance optimization.
