Authorization and Claims Analytics Data Analyst III Job at L.A. Care Health Plan (Los Angeles)

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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

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
Consults across business operations, providing mentorship, and contributing specialized knowledge

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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

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
Consults across business operations, providing mentorship, and contributing specialized knowledge

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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

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

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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 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

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

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

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

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

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Instructional Designer

We’re looking for an experienced Instructional Designer with proven experience i...

Location

United States , Reading

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Instructional Design, L&D, HR, or related field
Experience designing training in a corporate or enterprise environment
Proven experience in learning design within an HRIS or enterprise systems environment
Proficiency with eLearning tools (e.g., Articulate, Captivate, Camtasia) and LMS platforms
Familiarity with Oracle HCM or similar HRIS platforms preferred
Working knowledge of AI applications within learning and development
Proficient in Microsoft 365 applications including Teams, SharePoint, and PowerPoint
Strong communication, project management, and problem-solving skills
Ability to work independently and manage multiple priorities

Job Responsibility

Design and develop eLearning, videos, job aids, and other training materials
Apply instructional design best practices to create effective, user-centered learning experiences
Partner with stakeholders to assess training needs and recommend solutions
Use data and feedback to measure effectiveness and improve learning programs
Support system rollouts and process changes through training and change management
Continuously identify opportunities to improve and innovate learning strategies

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

New

Associate Quality Complaints

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Bachelor's degree and 2 to 4 years of in Pharma/Life Sciences/Biotechnology
Master's degree and 1 to 3 years of in Pharma/Life Sciences/Biotechnology Experience

Job Responsibility

Own and implement the end-to-end global complaint process and management system
Evaluate and ensure triaged product complaint records stay in sync with applicable procedures
Evaluate and manage customer feedback records to closure
Evaluate records that have been determined to be voided and complete the void process
Own records with limited information
Complete assigned assessments per applicable procedures
Ensure quality of complaint records
Drive the complaint process per SOP requirements
Own or handle the review/approval process flow in CDOCS of controlled documents
Support management of assigned projects or project tasks

Fulltime

New

Clinical Reviewer Specialist

Performs clinical reviews needed to resolve and process appeals by reviewing med...

Location

Philippines , Manila

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

RN - Registered Nurse - State required Licensure and/or Compact State Licensure
Knowledge of utilization management process
Knowledge of NCQA, Medicaid regulations
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills
1-3 years of experience in processing appeals or utilization management

Job Responsibility

Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
Communicates with providers, facilities and other departments regarding appeal requests
Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeal requests
Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
Uses sound judgement, especially in non-routine appeals, to make decisions to keep the appeal process moving forward in accordance with contractual timeliness standards
Maintain files on individual appeals by gathering, analyzing and reporting verbal and written member and provider appeals
Review claim appeal for reconsideration and recommend approvals/denials based on determination level or prepare for medical review presentation
Prepare case recommendations for medical review as necessary

Fulltime

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Authorization and Claims Analytics Data Analyst III

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Authorization and Claims Analytics Data Analyst III

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