HC Domain SME Data Analyst

Job Description

Must Have Technical/Functional Skill

We are seeking a Strong Healthcare Domain SME with knowledge of Med Econ, Milliman Med Insight (Claims Analytics Platform)/ Data Analyst and a solid understanding of Value-Based Care (VBC) models.

The candidate will act as an individual contributor, supporting analytical needs across complex healthcare datasets, enabling actionable insights, and handling operational requests related to reporting and claims analysis.

The ideal candidate is hands‑on, analytical, and comfortable working independently in fast‑paced environments involving Databricks, Power

BI, Service Now, and healthcare data sources.

• Domain Expertise:
  Strong experience in the healthcare domain, especially Claims data and healthcare operations, Provider reimbursement models, Performance and quality reporting.
• Solid understanding of Value-Based Care (VBC) concepts and performance measurement.
• Strong knowledge of Milliman Med Insight (Claims Analytics Platform).
• Technical & Analytical
  
  Skills:
  
  Excellent analytical and problem‑solving skills with the ability to work on large, complex datasets.
• Ability to analyze complex, multi‑source healthcare data and translate results into clear business insights.
• Strong critical thinking skills with a focus on answering “why” and “so what” for business stakeholders.
• Proven hands‑on experience working in a Databricks environment (SQL, notebooks, data exploration).
• Strong SQL skills for querying, validating, and analyzing healthcare data.
• Experience supporting ad‑hoc analytical and reporting requests.
• Tools & Platforms:
  Experience with Service Now for ticket management, triage, and incident resolution; familiarity with healthcare data platforms, data warehouses, and reporting tools (Power BI).

• Prior experience supporting payer, provider, or population health analytics teams.
• Exposure to quality, cost‑of‑care, utilization, or risk adjustment analytics.

• Serve as a subject matter expert for healthcare analytics, with a strong focus on Value-Based Care models (e.g., shared savings, capitation, quality measures).
• Translate business requirements into clear functional specifications and analytical solutions.
• Partner with business stakeholders, clinical teams, and technical teams to ensure alignment between business needs and data outputs.
• Analyze healthcare trends across claims, member, and provider data to support performance reviews and operational decisions.
• Provide insight into healthcare metrics such as utilization, cost drivers, quality performance, and provider/member behavior.

• Perform complex data analysis using data from multiple healthcare sources, such as:
• Claims (medical, pharmacy)
• Eligibility and enrollment data
• Provider and member data
• Quality and performance metrics
• Design and deliver ad‑hoc and recurring reports using Databricks and associated analytics tools.
• Validate data accuracy, identify trends, anomalies, and performance gaps, and communicate insights clearly.

• Respond to Service Now tickets, performing triage, impact analysis, root‑cause assessment, and resolution for data and reporting issues.
• Support claims‑related inquiries, including investigation of data discrepancies, processing issues, and business‑rule validation.
• Ensure timely closure of tickets with proper documentation and stakeholder communication.

• Act as a trusted analyst for business users, supporting data‑driven decision‑making.
• Clearly explain analytical findings to both technical and non‑technical audiences.
• Provide recommendations based on data insights to improve operational, clinical, or financial outcomes.

$160,000-$190,000 Per year

• Discretionary Annual Incentive.
• Comprehensive Medical Coverage:
  Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
• Family Support:
  Maternal & Parental Leaves.
• Insurance Options:
  Auto & Home Insurance, Identity Theft Protection.
• Convenience & Professional Growth:
  Commuter Benefits & Certification & Training Reimbursement.
• Time Off:
  Vacation, Time Off, Sick Leave & Holidays.
• Legal & Financial Assistance:
  Legal Assistance, 401(K) Plan, Performance Bonus, College Fund, Student Loan Refinancing.

BACHELOR OF COMPUTER SCIENCE