Healthcare Analyst II

Who We Are Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Job Summary Conduct analysis and data development for a broad range of financial and actuarial functions. This support will include rate reviews, financial planning and projections, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical cost containment analysis. This role will work closely with a variety of departments including underwriting, sales, contracting, and medical management. An understanding of the health insurance industry as well as proficiency in relational databases, data warehouses, Excel and statistical modeling as well as strong interpersonal skills are required. Key Responsibilities/Duties – what you will be doing Planning, Design, Project/Process Management Performs analytic project work assigned by manager with minimal supervision Develops analytic project plan to meet defined objectives Facilitates planning and review sessions Technical Analysis Uses Healthplan data systems and query tools to complete work projects, developing new code and tools to meet objectives Checking/Validation/Peer Review Develops criteria to validate results in light of prior expectations; investigate unusual results and offers explanations Analysis/Interpretation Examines and interprets results in the context of the specific business questions being addressed Identifies new questions and/or unforeseen data complexities arising from results and takes steps to address them Communication/Presentation of Results Packages results to demonstrate how the analysis meets project objectives Other duties as assigned Qualifications – what you need to perform the job Qualifications (Minimum education & experience level required): College degree required 2 years experience 2-4 exams Skill requirements (include complexity of position): Analytic: Demonstrated experience in analytic work Technical: Proficiency in the use of personal computers, relational databases, statistical packages, spreadsheet and/or database applications Communication/Presentation skills: Well-developed verbal and written skills Ability to facilitate planning and review sessions Developing presentation skills, presents mostly within department and to project teams Negotiation/Leadership skills: Able to operate in a matrix environment Able to implement Actuarial department standards and processes. Independence/Judgment: Receives regular management oversight of selected tasks, projects and processes Increasingly applies own judgment to analytical/technical issues Interpersonal skills (include personal interaction): Must be able to work cooperatively as a team member. Regular interface with various levels of staff and management is required as well. Confidential data: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material. Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times. Working Conditions or Additional requirements (include special requirements, e.g., lifting, travel, overtime) Unlimited access to confidential member and provider specific data, as needed. Fast paced office environment. Works on personal computer approximately 70% of the time. Must be able to exercise appropriate judgment, as necessary. Open cubicle work setting with personal computer. Commitment to Diversity, Equity & Inclusion Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. COVID Policy Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law. At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.