Medicon/MedEcon (Healthcare Domain SME) Data Analyst-Fully remote (Riverside)

Must Have Technical/Functional Skill

We are seeking a Strong Healthcare Domain SME with knowledge of MedEcon, Milliman MedInsight(Claims Analytics Platform)/ Data Analyst and a solid understanding of Value-Based Care (VBC) models.

The candidate will act as an individual contributor, supporting analytical needs across complex healthcare datasets, enabling actionable insights, and handling operational requests related to reporting and claims analysis.

The ideal candidate is hands-on, analytical, and comfortable working independently in fast-paced environments involving Databricks, PowerBI, ServiceNow, and healthcare data sources.

Must Have Technical/Functional Skills

• Domain Expertise

o Strong experience in the healthcare domain, especially:

 Claims data and healthcare operations

 Provider reimbursement models

 Performance and quality reporting

o Solid understanding of Value-Based Care (VBC) concepts and performance measurement.

o Strong knowledge of Milliman MedInsight(Claims Analytics Platform)

• Technical & Analytical Skills

o Excellent analytical and problem-solving skills with the ability to work on large, complex datasets.

o Ability to analyze complex, multi-source healthcare data and translate results into clear business insights.

o Strong critical thinking skills with a focus on answering “why” and “so what” for business stakeholders.

o Proven hands-on experience working in a Databricks environment (SQL, notebooks, data exploration).

o Strong SQL skills for querying, validating, and analyzing healthcare data.

o Experience supporting ad-hoc analytical and reporting requests.

• Tools & Platforms

o Experience with ServiceNow for ticket management, triage, and incident resolution.

o Familiarity with healthcare data platforms, data warehouses, and reporting tools(Power BI) is preferred.

Preferred Qualifications

• Prior experience supporting payer, provider, or population health analytics teams.

• Exposure to quality, cost-of-care, utilization, or risk adjustment analytics.

Roles & Responsibilities

Business & Functional Analysis

• Serve as a subject matter expert for healthcare analytics, with a strong focus on Value-Based Care models (e.g., shared savings, capitation, quality measures).

• Translate business requirements into clear functional specifications and analytical solutions.

• Partner with business stakeholders, clinical teams, and technical te ams to ensure alignment between business needs and data outputs.

• Analyze healthcare trends across claims, member, and provider data to support performance reviews and operational decisions.

• Provide insight into healthcare metrics such as utilization, cost drivers, quality performance, and provider/member behavior.

Data Analysis & Reporting

• Perform complex data analysis using data from multiple healthcare sources, such as:

o Claims (medical, pharmacy)

o Eligibility and enrollment data

o Provider and member data

o Quality and performance metrics

• Design and deliver ad-hoc and recurring reports using Databricks and associated analytics tools.

• Validate data accuracy, identify trends, anomalies, and performance gaps, and communicate insights clearly.

Operational Support & Issue Triage

• Respond to ServiceNow (SNOW) tickets, performing triage, impact analysis, root-cause assessment, and resolution for data and reporting issues.

• Support claims-related inquiries, including investigation of data discrepancies, processing issues, and business-rule validation.

• Ensure timely closure of tickets with proper documentation and stakeholder communication.

Stakeholder Collaboration

• Act as a trusted analyst for business users, supporting data-driven decision-making.

• Clearly explain analytical findings to both technical and non-technical audiences.

• Provide recommendations based on data insights to improve operational, clinical, or financial outcomes.