Insurance Analyst / Analytics Engineer

Harbor Health is on a mission to disrupt the outdated US healthcare system by creating a new approach to care. The Insurance Analyst / Analytics Engineer will drive actionable intelligence across integrated insurance operations, collaborating with various teams to enhance data infrastructure and improve usability of data assets.

Responsibilities:

• Build and maintain the semantic layer/metrics; define KPI logic and reusable models that power dashboards and self-serve reporting
• Translate business questions into performant SQL and polished dashboards in our BI tool (Omni); ship clean, drill-friendly reports
• Collaborate with stakeholders to customize reporting and data workflows
• Help implement and monitor ETL/ELT to land and transform data from databases, files, and APIs
• Manage schema changes and migrations with version control and backward-compatible rollouts
• Develop and deploy forecasting models (e.g., regression, time-series) to power forecasting reports and alerts
• Collaborate with data engineering team to support on business logic as part of typical build processes
• Own monthly KPI reporting revenue operations including net premium PMPM, retro eligibility adjustments, grace-period exposure PMPM
• Monitor enrollment integrity and subsidy reconciliation, flagging financial exposure from ineligible members, retro adjustments, or APTC grace-period risk
• Build and maintain financial models that incorporate leading indicators (auth data, ADT feeds, pharmacy claims) into forward-looking cost projections
• Produce and maintain core utilization metrics: PCP visits/1,000, specialist visits/1,000, ER visits/1,000, avoidable ER rate, readmission rate, LOS, and LOC
• Develop leading indicator dashboards using pre-claims data source (e.g., ADT feeds, authorization data, eligibility checks Athena, Zus, and pharmacy-claims)
• Identify and continuously monitor high-cost claimants using a multi-signal approach; paid and inventory claims, auth data, ADT, pharmacy, and EMR data

Requirements:

• 3-6 years of experience in healthcare analytics within a managed care, health plan, or payvidor environment
• Deep familiarity with payor data structures: claims, eligibility/834 transactions, authorization data, ADT feeds, and risk adjustment data
• Strong SQL proficiency; experience querying data warehouses such as Snowflake
• Demonstrated ability to build and maintain PMPM-based reporting, utilization analytics, and population health dashboards
• Understanding of ACA-specific constructs: APTC grace periods, CSR tiers, risk adjustment under the V28 model
• Ability to translate complex analytics into clear, actionable narratives for operational and executive audiences
• Experience with data visualization tools such as Omni, Looker, PowerBI, etc
• Familiarity with EMR data (Athena preferred) and multi-system data integration across clinical and financial sources
• Experience building ETL/ELT and data processing pipelines using dbt
• Hands-on experience with relational databases and data warehouses
• Understanding of data modeling principles (star/snowflake schema, normalization/denormalization)
• Familiarity, excitement and comfort working in the HealthTech industry; strong plus if already familiar with key healthcare data concepts
• Interest and understanding in Harbor Health's 'payvidor' business model, and the enormous impacts it will have on the American healthcare system