Senior Data Analyst, Clinical Programs

Brighton Health Plan Solutions is a healthcare enablement company that partners with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs. We provide flexible, cutting-edge third-party administration services to solve today’s healthcare challenges, leveraging decades of health plan management expertise, proprietary provider networks, and an innovative technology platform.

About the role

This remote position is an analytically driven role supporting BHPS Clinical Programs, Utilization Management, Complex Case Management, and Population Health Management. The Senior Data Analyst will collaborate with stakeholders to understand business needs, analyze data, and develop actionable insights to inform client and program strategy.

Responsibilities

• Monitor Utilization Management and Case Management activities through the development of KPIs and benchmarks (e.g., member engagement rates, readmissions, preventable hospitalizations, ER utilization).
• Develop statistical models that deliver meaningful insights on cost, utilization, and clinical outcomes from various data sources.
• Create algorithms for stratifying populations and identifying high-risk members.
• Leverage Predictive Analytics to measure the performance (ROI) of Disease Management and other Medical Management programs.
• Conduct prospective savings analyses in support of clinical program initiatives.
• Build and maintain client-facing reports, dashboards, and analyses.
• Develop actionable data insights and advise on client strategy.
• Participate in program performance review presentations with clinical program managers, client account managers, and external clients as needed.
• Manage internal and external client requests and timelines to ensure timely delivery.
• Collaborate with Medical Management to provide ongoing support.

Requirements

• Bachelor’s degree required, preferably in Mathematics, Statistics, Finance, Actuarial Science, Data Science, or a related field.
• 5-7 years of experience in healthcare analytics, preferably in a managed care setting.
• Proficiency in SQL and Microsoft SQL Server Suite of Products (SSMS).
• Proficiency in MS Excel.
• Advanced data analysis, financial modeling, and predictive analytics skills.
• Experience with clinical program evaluation and outcomes reporting.
• Experience with health plan performance reporting and cost and utilization analysis.
• Experience developing client-facing reports.
• Experience with Business Intelligence applications and DAX functions (PowerPivot, Power BI, Tableau).
• Ability to explain technical concepts to a non-technical audience.
• Ability to effectively manage and prioritize several concurrent projects.
• Excellent oral and written communication skills.
• Experience with Payer Care Management platforms (e.g., ZeOmega) is a plus.