Operations Data Analyst II

Come Grow With Us At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges. Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person – health, health care, and social services and supports – are met.

We are seeking collaborators, innovators, and those who are driven to be their very best. If you are looking for a career of purpose and are passionate about having an impact on society’s health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.

Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
This position is open to California residents only

• Perform advanced statistical and quantitative analysis of healthcare, operational, claims, encounter, membership, and other enterprise data.
• Develop statistical models and algorithms to identify anomalies, patterns, trends, risks, and opportunities that support operational and strategic decision-making.
• Apply appropriate statistical methodologies including regression, hypothesis testing, forecasting, segmentation, outlier detection, trend analysis, and other quantitative techniques.
• Develop and maintain analytical solutions using SQL, Python, R, Power BI, and other approved analytical tools.
• Serve as the analytical owner or subject matter resource for assigned operational domains.
• Develop enterprise dashboards, reports, data visualizations, and analytical products that translate complex information into actionable business insights.
• Automate recurring analytical processes, regulatory metrics, operational KPIs, and data validation activities.
• Analyze large and complex datasets from multiple sources and identify relationships, trends, data-quality issues, and opportunities for improvement.
• Perform data profiling, validation, reconciliation, and quality analysis to ensure analytical outputs are accurate, complete, and appropriate for their intended use.
• Develop and maintain data models, analytical datasets, data definitions, and source-to-target mapping documentation.
• Partner with business stakeholders to define analytical questions, identify appropriate methodologies, establish measures of success, and translate findings into business recommendations.
• Collaborate with Information Technology, Enterprise Analytics, developers, data engineers, consultants, and other technical resources to improve enterprise data assets and analytical capabilities.
• Support development and enhancement of enterprise data warehouse solutions, including Microsoft Azure Synapse and other approved platforms.
• Develop analytical solutions supporting regulatory and operational functions including Grievances & Appeals, Encounters, Risk Adjustment, Claims, Membership, and related areas.
• Evaluate patterns and anomalies within claims and encounter data that may indicate operational issues, payment variation, data-quality concerns, or opportunities for further investigation.
• Develop methodologies to measure operational performance, identify statistically significant variation, and evaluate the effectiveness of operational interventions.
• Perform exploratory data analysis to identify opportunities for new analytical models, measures, and decision-support tools.
• Clearly document analytical methodologies, assumptions, limitations, data sources, and results.
• Present complex analytical findings to technical and non-technical audiences in a clear and actionable manner.
• Provide analytical guidance and technical support to Data Analyst I staff and other members of the Operations Analytics team as appropriate.
• Participate in…