Senior Analyst, Government Programs Operations - Analysis & Efficiencies

Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC)

Position Summary:

The Senior Analyst, Government Programs Operations - Analysis & Efficiencies supports the operational success of Medicare, Medicaid, Exchange, and Commercial plans by developing data-driven solutions that improve efficiency, strengthen accuracy, and reduce manual effort. Under the guidance of the Operations Manager, the analyst evaluates complex datasets to identify actionable insights, inform strategic decisions, and drive continuous improvement. Key responsibilities include producing recurring and ad hoc reports, designing and implementing business intelligence dashboards, and creating standardized code templates to automate deliverables. The analyst also supports reversal and reprocessing (R&R) activities by conducting impact analyses, preparing supporting data, and validating post-fix and reprocessed results to confirm that expected outcomes are achieved. In partnership with Client Analytics, the analyst reviews and validates analytical outputs for accuracy, completeness, and alignment with business requirements before client delivery. The role also develops scalable, automated solutions that streamline workflows and collaborates with cross-functional teams-including Compliance, Product, Sales, Marketing, Underwriting, Implementation, Client Services, and Clinical Operations-to ensure analytical tools and operational capabilities align with regulatory requirements and business objectives

Position Responsibilities:

• Analyze complex datasets to identify trends, outliers, and opportunities for operational improvement across Medicare, Medicaid, Exchange, and Commercial plans.
• Develop and maintain recurring and ad-hoc reports, dashboards, and analytical tools to support data-driven decision-making.
• Create and maintain a repository of standardized code templates to streamline report generation and automate routine tasks.
• Ensure analytical outputs align with applicable regulatory requirements and business objectives by interpreting CMS, state, Exchange, and Commercial requirements in partnership with internal subject matter experts.
• Support the development of scalable processes that enhance efficiency, accuracy, and responsiveness across Medicare, Medicaid, Exchange, and Commercial operations.
• Design and implement automated solutions to reduce manual effort and improve process scalability and accuracy.
• Implement and use analytical software to support the department in achieving goals as defined by executive leadership.
• Facilitate requirements-gathering sessions to understand business needs and translate them into actionable analytical deliverables.
• Analyze business workflows and system needs for conversions and migrations to ensure that encounter, recovery, cost-savings, and other applicable requirements are met.
• Support R&R activities by performing impact analysis, preparing supporting data, and evaluating expected member, client, financial, and operational impacts.
• Perform post-fix and post-reprocessing validation by comparing original and reprocessed outcomes, identifying variances, and confirming that implemented corrections produced the expected results.
• Present and communicate complex analytical findings in a clear and concise manner.
• Participate in user acceptance testing and quality assurance testing of new application features, system fixes, reprocessing activities, and team deliverables.
• Support root-cause analysis and reporting of claims, encounter, and other data issues or errors by partnering with key stakeholders; also provide operational support.
• Partner with Client Analytics to review and validate analytical outputs for accuracy, completeness, and alignment with business requirements prior to client delivery.
• Collaborate with cross-functional teams-including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations-to refine and enhance operational capabilities.

Required Qualifications:

• 4+ years of healthcare data experience supporting Medicare, Medicaid, Exchange, Commercial, or other health plan operations.
• 4+ years of experience working with SQL, R, or Python.
• 4+ years of experience performing analyses on large datasets, including impact analysis and validation of data before and after system fixes or reprocessing.
• Experience supporting reversal and reprocessing activities, claims adjustments, remediation efforts, or comparable operational correction processes.
• Knowledge of data management, statistics, and modeling concepts.
• Experience working with cross-functional teams.
• Experience with Tableau or other data visualization tools.
• Ability to balance multiple complex projects simultaneously.
• Extremely flexible, highly organized, and able to shift priorities easily.
• Attention to detail and commitment to delivering a high-quality work product.

Preferred Qualifications:

• 4+ years of proven experience in government programs
• 3+ years of experience working with pharmacy data
• Experience with Medicare(Part D), Medicaid, and/or Marketplace Pharmacy Data/Processes