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L.A. Care Health Plan Logo L.A. Care Health Plan · IT - Administration

Authorization and Claims Analytics Data Analyst III

United States, Los Angeles 88854.00 - 142166.00 USD / Year · Job Posted January 22, 2026
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Job Description

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs. The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Job Responsibility

  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Identifies areas where technical solutions would improve business performance
  • Consults across business operations, providing mentorship, and contributing specialized knowledge
  • Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices
  • Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed
  • Perform other duties as assigned

Requirements

  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
  • Proficiency in data validation, reconciliation, and adherence to governance standards
  • Ability to translate complex business problems into structured analytic requirements and actionable insights
  • Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals
  • Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains
  • Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs
  • Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment
  • Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment
  • Ability to mentor junior analysts and promote adherence to analytic best practices
  • Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately
  • Ability to communicate findings effectively to both technical and non-technical stakeholders
  • Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution
  • Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams
  • Ability to analyze operational Key Performance Indicators (KPIs) (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights

Nice to have

  • Master's Degree
  • Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling
  • Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis
  • Experience mentoring junior analysts or providing guidance on analytic best practices
  • Proficient with Process Improvement Methodology including defining and documenting workflow
  • Knowledge of program and project level planning, mobilization and management
  • Tableau Certified Data Analyst or Tableau Desktop Specialist
  • Microsoft Certified: Power BI Data Analyst Associate
  • Snowflake SnowPro Core Certification
  • SnowPro® Specialty: Snowpark Certification
  • SQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)
  • Certified Health Data Analyst (CHDA)
  • Managed Care Professional (MCP) or relevant certification

What we offer

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
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  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
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