About this role

Monitor denials, approvals, and partial approvals using industry-standard SPC and control charting
Distinguish normal variation from data shifts that signal a need for process review
Take raw, unpolished extracts and transform them into meaningful control charts and actionable insights
Assist in designing and implementing healthcare IT solutions to meet business needs and regulatory requirements
Present findings focusing on interpretation over polish
Stay current on SPC signal rules and apply them to improve validation workflows

3-5 years in a health plan or healthcare services company
3+ years in healthcare operations (Authorizations or Claims)
Expert Excel Skills: Must be proficient in Power Query, Pivot Tables, and advanced formulas
Statistical Proficiency: Demonstrated ability to apply Standard Deviation and Control Charting to operational outcomes
Bachelor's degree in Health Informatics, Business, or a related field (or 7+ years of direct experience)
Hands-on SQL experience for data extraction and transformation (preferred)
A background in Lean Six Sigma or quality improvement analytics (preferred)

Data Analyst, Quality & Business Performance

Key skills