Healthcare Economics Data Analyst II

Own recurring healthcare economics analytics and translate results into actionable recommendations for business and clinical teams.

Responsibilities

• Independently design and complete moderately complex analyses across cost, utilization, unit cost, service mix, pharmacy spend, membership, risk scores, quality performance, and population health outcomes.
• Own recurring dashboards, scorecards, worklists, and reporting packages from data extraction through validation, interpretation, and delivery.
• Build reusable SQL queries, data models, business rules, and automated reporting processes to improve timeliness and consistency.
• Conduct drill-down analyses by provider, medical group, product, region, risk type, member segment, diagnosis, procedure, and site of care.
• Support risk adjustment financial analytics, including RAF trend, suspect and recapture opportunities, coding pattern, submission status, and intervention performance.
• Support Stars/Quality analyses, including measure performance, care gaps, provider variation, intervention targeting, and outcome tracking.
• Develop population health cohorts, including risk stratification, chronic-condition prevalence, avoidable utilization, outreach prioritization, and pre/post program evaluations.
• Evaluate care management, pharmacy, quality, vendor, and culturally attuned benefit programs using utilization, engagement, outcome, satisfaction, and financial measures.
• Investigate data anomalies, reconcile multiple sources, assess limitations, and recommend corrective actions.
• Present findings and recommendations to managers and cross-functional partners; contribute to executive-ready materials.
• Gather requirements, define metrics, manage project timelines, and communicate risks or dependencies.
• Provide peer review and technical guidance to Level I analysts.
• Maintain compliance with HIPAA, CMS, corporate, and departmental requirements.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree in Healthcare Administration, Finance, Economics, Actuarial Science, Statistics, Data Analytics, Public Health, Business, Information Systems, or a related field.
• 3 to 5 years of experience in healthcare analytics, healthcare economics, financial analytics, or managed care reporting.
• Demonstrated experience with SQL, Excel, and Power BI or a comparable reporting tool.
• Experience analyzing claims, membership, pharmacy, utilization, risk adjustment, quality, or population health data.
• Medicare Advantage or managed care experience strongly preferred.
• Intermediate to advanced skills in SQL, Excel, data visualization, and relational databases.
• Strong analytical and critical-thinking skills, including trend, variance, cohort, and financial-impact analysis.
• Working knowledge of Medicare Advantage economics, claims, risk adjustment, Stars/Quality, population health, and value-based care concepts.
• Ability to translate complex analyses into clear conclusions, limitations, and recommended actions.
• Strong project management, documentation, stakeholder communication, and presentation skills.
• Ability to work independently, prioritize competing assignments, and provide constructive peer review.
• High attention to data integrity, confidentiality, and compliance.

Technologies

• SQL
• Excel
• Power BI

Work Location and Schedule

• Huntington Beach, CA (hybrid).
• Hybrid work schedule.
• Requires 3 days onsite at the Huntington Beach office.

Compensation

• $81,500/year to $100,000/year.
• Salary ranges reflect California wages; compensation may vary based on state residency.

Physical and Working Environment

• Office environment and/or remote hybrid setting.
• Ability to operate a keyboard, mouse, and phone; perform repetitive motion; sit for long periods; stand, reach, bend; and lift up to 15 lbs.
• Ability to convey information and detailed instructions accurately.
• May occasionally require irregular hours based on business needs.

Equal Employment Opportunity

• Clever Care Health Plan is an Equal Employment Opportunity and Affirmative Action workplace.
• Background check required.