Define payer-grade outcomes measurement for care navigation and wellness programs: savings, quality, utilization, engagement—using transparent methodology, assumptions, and exclusions suitable for actuarial/client analytics review
Claims + clinical/engagement data integration: design data requirements and pipelines that combine medical/Rx claims, eligibility, risk scores, care management/case notes (as applicable), vendor feeds, and navigation engagement signals
Utilization and site-of-care impact analysis: quantify shifts in ED, inpatient admits, readmissions, avoidable visits, outpatient steerage, and guideline-based care gaps closure attributable to navigation/wellness interventions
Population stratification & targeting analytics: segment members by risk, condition, rising-risk, and likelihood-to-engage; identify where navigation and wellness can drive measurable economic value
Support contracting & renewals with evidence: partner with Sales/Client Success to define measurement language in SOWs, set reporting expectations, and provide credible performance narratives for renewals/expansions
Clinical-program translation to economics: connect operational levers to downstream utilization and cost impacts
Measurement governance & QA: implement audit trails, reproducible analyses, and data quality checks to ensure reliability of published results.

10+ years healthcare analytics + medical economics, public health or statistics experience with payer claims and value measurement (PMPM, trend, utilization, quality)
Strong methods background in outcomes evaluation / quasi-experimental design; ability to explain methodology clearly to non-technical and actuarial audiences
Hands-on technical skills: advanced SQL plus Python or R; comfort building reusable analytic datasets; BI/dashboarding experience for client and internal reporting
Experience with navigation/wellness metrics: engagement funnels, time-to-care, appointment completion, care gap closure, HEDIS-like measures (as relevant), program adherence, and linking these to utilization/cost
Client-facing communication: can write methodology memos and present results with appropriate caveats; confident interacting with payer analytics/actuarial counterparts
Cross-functional influence: demonstrated ability to align Product, Clinical/Operations, and Commercial teams on definitions, data needs, and measurement commitments.

Clinical Data Analyst

Key skills