Manager, Operational Analytics

November 25

Apply Now

Receive Emails with Similar Jobs

Peak Health

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

📋 Description

• Collaborate closely with the Director, Operational Analytics, across product, operations, medical management, and provider contracting to support and implement high-quality, data-driven decisions. • Ensure data accuracy and consistent reporting by designing, creating optimal processes and procedures for analytics employees to follow. • Use advanced data modeling, predictive modeling, and analytical techniques to interpret key findings from company data. • Build, develop and maintain data models, reporting systems and performance metrics to support key business decisions. • Support the submission of the Prescription Drug Data Collection (RxDC) Reporting suite of regulatory reports for employer-sponsored group health plans. • Ensure compliance with all applicable regulatory requirements, guidelines, and contractual obligations set forth by CMS. • Work closely with Quality, Risk Adjustment, Analytics, Finance, Actuarial, Provider Networking/Relations, and other teams within the company to execute on business objectives.

🎯 Requirements

• Bachelor’s Degree in Business Administration, Finance, Mathematics, Computer Science, Statistics, Information Systems, or a related field. • Six (6) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company. • Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk. • Foundational understanding of health plan economics and financial drivers. • Master’s Degree in Business Administration, Computer Science, Statistics, Information Systems, or a related field. • Experience working in an analytic capacity collaboratively with Medical Economics, Risk Adjustment, Quality, Actuarial or Finance functions within an insurer focused in Government/Commercial products. • Experience with Medicare and/or Medicaid Regulatory Reporting. • Foundational understanding of prescription drug programs.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off