Analyst, Operations Performance - Jefferson Health Plan

Job Description

Utilize advanced SQL techniques (complex joins, subqueries, CTEs, pivots, ranking, and data mining) to extract, analyze, and validate operational data.
Develop claim and operational data models to forecast financial impacts, identify issues, and support business initiatives.
Design, automate, and maintain standardized weekly, monthly, and quarterly reports, dashboards, and executive summaries.
Leverage SQL, Power BI, Excel, and other reporting tools to transform data into actionable insights for leadership and operational teams.
Analyze operational and HP system data to identify processing anomalies, data integrity concerns, trends, and KPI performance drivers.
Perform root cause analysis, statistical evaluations, and data validation to support informed decision-making and continuous improvement.
Partner with stakeholders and quality teams to interpret findings, establish audit methodologies, and recommend process enhancements.
Monitor business process performance, document and escalate significant fluctuations, and provide data-backed recommendations to management.
Prepare and communicate reporting metrics for internal and external audiences, ensuring accurate performance tracking and executive visibility.
Support system upgrades, project implementations, and ongoing reporting requirements while maintaining SQL scripts and performance-monitoring tools.

Responsibilities

• Utilize advanced SQL techniques to extract, analyze, and validate operational data.
• Develop claim and operational data models to forecast financial impacts, identify issues, and support business initiatives.
• Design, automate, and maintain standardized reports, dashboards, and executive summaries.
• Leverage SQL, Power BI, Excel, and other tools to transform data into actionable insights.
• Analyze operational and HP system data to identify processing anomalies, data integrity concerns, trends, and KPI performance drivers.
• Perform root cause analysis, statistical evaluations, and data validation to support informed decision-making and continuous improvement.
• Partner with stakeholders and quality teams to interpret findings, establish audit methodologies, and recommend process enhancements.
• Maintain SQL scripts and performance-monitoring tools.
• Support system upgrades, project implementations, and ongoing reporting requirements.

Requirements

• Average 3 years of experience in claims and/or managed care operations.
• Strong working knowledge of SQL, Power BI, and Excel.
• Excellent verbal and written communication skills.
• Strong interpersonal skills and ability to collaborate with stakeholders.
• Proficiency in Microsoft Excel, Word, and Access.
• Experience with data warehouses and statistical analysis tools.

Qualifications

• Associate’s Degree Required.
• Bachelor’s Degree Preferred.

Skills

• Strong working knowledge of SQL, Power BI, and Excel.
• Excellent verbal and written communication skills.
• Strong interpersonal skills and ability to collaborate with stakeholders.
• Proficiency in Microsoft Excel, Word, and Access.
• Experience with data warehouses and statistical analysis tools.
• Knowledge of claims and/or managed care operations.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.