Healthcare Claims Analytics Data Jobs

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Sr. Data Analyst

Alignment Healthcare USA, LLC Orange, CA

Orange, CA

Today

$78k - $117k/yr Full time Senior Business Analytics Business Intelligence

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Job Description

Alignment Healthcare USA, LLC is seeking a Senior Data Analyst to support data-driven decisions across its healthcare operations. Based in Orange, CA, this onsite role focuses on analyzing large healthcare datasets, building reporting outputs, and applying statistical and predictive methods to improve operational efficiency.

In this position, you will help turn complex claims and member information into insights for strategic leadership, while also maintaining data accuracy and contributing to governance practices tied to regulatory and compliance needs.

What you will do

Analyze large datasets to identify trends, patterns, and insights related to healthcare claims, member behavior, utilization, costs, and key performance metrics.
Design and develop reports and dashboards using business intelligence tools such as Tableau and Power BI to share findings with stakeholders.
Perform statistical analysis and predictive modeling to support business decisions, cost savings opportunities, and improved outcomes.
Communicate actionable insights to senior management and cross-functional teams in a clear, concise manner.
Monitor and ensure the accuracy, completeness, and timeliness of healthcare data used for analysis and reporting.
Develop and implement data validation processes to maintain data integrity and reliability.
Assist in developing data governance standards and practices aligned with regulatory and compliance requirements.
Collaborate with Alignment departments, including Provider Contracting and Network Development, to evaluate contract rate trending impact and anomalies.
Identify opportunities to improve analysis processes, tools, and techniques to increase productivity and accuracy.
Stay current with industry trends, data analytics technologies, and healthcare regulations to strengthen data-driven decision-making.
Support finance and operations by developing predictive KPIs to forecast and manage Alignment’s business.
Take on other projects and duties as assigned.

Required qualifications

Minimum 3 years of experience as a Data Analyst.
2 years of experience with statistical modeling, data mining, and predictive analytics techniques.
High School Diploma or GED.
Bachelor’s degree or four years of additional experience in lieu of education.
Knowledge of Access, SQL, and/or other database programs.
Knowledge of healthcare data types, including claims, eligibility, medical records, and encounter data.
Intermediate proficiency with MS Excel (including Pivot tables and VLOOKUP).
Ability to communicate positively and professionally, provide leadership, teach, and collaborate with others.
Effective written and oral communication skills, with the ability to build and maintain constructive relationships with diverse stakeholders, including management, employees, and vendors.
Mathematical skills to perform calculations and compute simple statistics accurately.
Reasoning skills to prioritize tasks, solve complex problems, define issues, collect data, establish facts, draw conclusions, and design resolution approaches.
Problem-solving, organizational, and time management skills for a fast-paced environment.
Report analysis skills to comprehend and analyze statistical reports.

Preferred qualifications

Insurance and healthcare experience.
MBA.

Tools and technologies

Tableau
Power BI
Access
SQL
MS Excel (Pivot tables, VLOOKUP)

Additional knowledge areas

Principles and practices of finance administration related to accounting, budgeting, and auditing.
Understanding of CMS Premium payment methodologies for MA Health Plans, including 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 and activities within a Data Warehouse environment, including claim data, membership, eligibility, and revenue data.
Understanding of provider capitation contracts, development of capitation rates, contract carve outs, and 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 hospital and physician payment methodologies (including DRG, Per Diem, % of Billed, RBRVS, FFS, and Capitation) and other ancillary providers.
Develop new analysis and approaches to apply data in ways that create fresh business insights.

Compensation and location

Location: Orange, CA (onsite)
Pay range: USD 77,905 - 116,858 per year
Pay range may vary based on factors including market location, education, responsibilities, and experience.

Phishing scam notice

Alignment Health and its subsidiaries will never ask candidates for a credit card, send checks, or request payment as part of employment consideration. If you believe you have encountered a scam, report it to the FTC at https://reportfraud.ftc.gov/. To verify the legitimacy of an email from Alignment Health’s talent acquisition team, email careers@ahcusa.com.

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