Job Summary
This is an exciting opportunity for a Senior Data Analyst looking to make a significant impact in the healthcare industry. You will play a crucial role in supporting the Risk Adjustment Department's data submission functions. This includes handling submissions to CMS and state agencies, managing internal data reconciliations, and facilitating data transfers between Point32Health and external partners.
As a Senior Data Analyst, your strong analytical skills will enable you to synthesize large data sets into actionable insights. You'll work collaboratively across various business areas, leading projects that demand problem-solving expertise and effective communication.
Key Responsibilities
Data Submission Integrity
Support the director in key activities, including monthly encounter data submissions to state agencies and CMS.
Monitor response files for encounter data/APCDs to identify and resolve discrepancies promptly.
Analyze monthly error reports and collaborate with relevant business areas to address critical errors.
Enhance and automate reconciliations and reporting using advanced SAS or SQL skills.
Interface with IT to implement improvements and resolve production issues related to state government and risk adjustment submissions.
Reporting and Data Management
Create monthly dashboards using Tableau, Cognos, and Excel to track submission trends and acceptance rates.
Generate various reconciliations and ad hoc reports using SAS for data extraction and transformation.
Assist the Strategy and Operations team with onboarding new program vendors through data file transfers and internal file reviews for accuracy.
Establish and manage secure data transfer methods with vendors.
Collaboration with Stakeholders
Work effectively with internal stakeholders, including Claims and Member Operations, to ensure process enhancements are effectively maintained.
Collaborate with federal agencies and vendor staff to stay informed of updates from EOHHS and other state agencies.
Communicate regulatory updates to team members and escalate risks as needed.
Data Analysis
Perform ad hoc analyses related to risk score trends and program performance to support risk adjustment analytics.
Compile and present information for different audiences, including supporting documents and graphics.
Administration
Attend relevant meetings, documenting key decisions and managing follow-up actions.
Serve as a point of contact for various initiatives within the department.
Help create and manage policies and procedures for the department.
Qualifications
Education:
Bachelor's degree required, preferably in a related field such as health informatics or business analysis.
Experience:
3-5 years of analytical experience in healthcare, preferably within a health plan or provider group.
Familiarity with claims systems, Medicaid/Medicare, and large data sets is preferred.
Skills:
Detail-oriented, resourceful, and able to engage in critical thinking.
Expertise in SAS, SQL, and experience with database software such as SQL Server or Oracle.
Experience with tools like Tableau and Excel.
Strong communication skills and ability to work collaboratively.
Proficient in managing tasks and following through to completion.
Working Conditions
Flexibility to work from home as required.
This position may require extended periods of sitting and simultaneous phone/PC usage.
Additional hours beyond the standard schedule may be necessary.
Commitment to Diversity, Equity & Inclusion
Point32Health values diversity and inclusion. We welcome applicants from all backgrounds and are committed to ensuring equal opportunities in employment.
About Us
Point32Health is a leading health and wellbeing organization dedicated to providing personalized healthcare experiences. We aim to make navigating health and wellbeing easier through various health plans and tools.
Scam Alert:  Point32Health does not request payments from applicants during the hiring process. Please contact us if you have questions about job postings or recruitment communications.
Req ID: R8273

Job Summary
Under the supervision of the Director of Data and Reporting, this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state agencies. The individual will handle internal data reconciliations and data transfers between Point32Health and external stakeholders such as vendors and provider organizations.
This role requires strong analytical skills and the ability to synthesize large data sets and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow complex business processes, consider options when problems arise, and identify and escalate issues appropriately.
Key Responsibilities/Duties – what you will be doing
Data Submission Integrity
Support the director across a range of activities, including monthly encounter data submission to the Executive Offices of Health and Human Services (RI and MA), CMS and APCD (All-Payer Claims Database) submissions to state agencies.
Monitor ongoing encounter data/APCDs response files to identify and address discrepancies in a timely manner.
Review monthly error reports, perform trend analysis, investigate critical errors, and work with the appropriate business area on resolution.
Enhance and automate existing reconciliation and reporting code using advanced SAS and/or SQL skills.
Interface with IT for the implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements, user acceptance testing, and post-implementation monitoring.
Reporting and Data Management
Use Tableau, Cognos, and Excel to create monthly submission dashboards and run submission reconciliations to effectively track acceptance rates and submission trends.
Create various reconciliations and ad hoc reports.
Use SAS to extract and transform data to create reports from multiple sources.
Assist Strategy and Operations team with the implementation of new program vendors, including data file transfers and reviews of internally received files for completeness, reasonableness, and accuracy.
Establish and manage data transfer methods with vendors, including working with IT to set up and manage secure file transfer sites for vendors that support our risk adjustment programs.
Collaboration with Internal/External Stakeholders
Collaborate effectively within risk adjustment department and other internal stakeholders, including Claims, Member Operations, Information Technology, and Provider Information, to ensure that process enhancements and submission mechanisms are maintained and monitored.
Collaborate with federal agencies, vendor data management staff, and industry trade associations to stay up to date with changes and updates from EOHHS and other state agencies.
Effectively communicate regulatory updates to the team and department leadership and escalate risks appropriately.
Data Analysis

Conduct ad hoc analyses specific to risk score trends, truncation report, data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups.
Create, compile, and format presentations for a variety of audiences, including supporting worksheets, graphics, and supplemental documents.
Administration
Attend meetings, document key decisions, manage follow up actions as necessary.
Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines.
Create and manage business policies and procedures and knowledge repositories for the department as needed.
QUALIFICATIONS – what you need to perform the job
EDUCATION, CERTIFICATION AND LICENSURE:
Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling.   EXPERIENCE (minimum years required) :

Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm.
Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data sets preferred.
Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated.
Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends.
Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL (SAS certification preferred).
Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos.
Experience with Alteryx, Cloudera and Tableau is a plus.
Proficient in Microsoft Excel, PowerPoint, and Word.
Strong interpersonal and communication skills.
Ability to work collaboratively with both internal and external resources.
Ability to take responsibility, prioritize tasks and follow through to completion.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel) :
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.
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.
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.
Scam alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.
Req ID: R8273

Job Summary
Under the supervision of the Director of Data and Reporting, this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state agencies. The individual will handle internal data reconciliations and data transfers between Point32Health and external stakeholders such as vendors and provider organizations.
This role requires strong analytical skills and the ability to synthesize large data sets and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow complex business processes, consider options when problems arise, and identify and escalate issues appropriately.
Key Responsibilities/Duties – what you will be doing
Data Submission Integrity
Support the director across a range of activities, including monthly encounter data submission to the Executive Offices of Health and Human Services (RI and MA), CMS and APCD (All-Payer Claims Database) submissions to state agencies.
Monitor ongoing encounter data/APCDs response files to identify and address discrepancies in a timely manner.
Review monthly error reports, perform trend analysis, investigate critical errors, and work with the appropriate business area on resolution.
Enhance and automate existing reconciliation and reporting code using advanced SAS and/or SQL skills.
Interface with IT for the implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements, user acceptance testing, and post-implementation monitoring.
Reporting and Data Management
Use Tableau, Cognos, and Excel to create monthly submission dashboards and run submission reconciliations to effectively track acceptance rates and submission trends.
Create various reconciliations and ad hoc reports.
Use SAS to extract and transform data to create reports from multiple sources.
Assist Strategy and Operations team with the implementation of new program vendors, including data file transfers and reviews of internally received files for completeness, reasonableness, and accuracy.
Establish and manage data transfer methods with vendors, including working with IT to set up and manage secure file transfer sites for vendors that support our risk adjustment programs.
Collaboration with Internal/External Stakeholders
Collaborate effectively within risk adjustment department and other internal stakeholders, including Claims, Member Operations, Information Technology, and Provider Information, to ensure that process enhancements and submission mechanisms are maintained and monitored.
Collaborate with federal agencies, vendor data management staff, and industry trade associations to stay up to date with changes and updates from EOHHS and other state agencies.
Effectively communicate regulatory updates to the team and department leadership and escalate risks appropriately.
Data Analysis

Conduct ad hoc analyses specific to risk score trends, truncation report, data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups.
Create, compile, and format presentations for a variety of audiences, including supporting worksheets, graphics, and supplemental documents.
Administration
Attend meetings, document key decisions, manage follow up actions as necessary.
Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines.
Create and manage business policies and procedures and knowledge repositories for the department as needed.
QUALIFICATIONS – what you need to perform the job
EDUCATION, CERTIFICATION AND LICENSURE:
Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling.    EXPERIENCE  (minimum years required)  :

Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm.
Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data sets preferred.
Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated.
Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends.
Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL (SAS certification preferred).
Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos.
Experience with Alteryx, Cloudera and Tableau is a plus.
Proficient in Microsoft Excel, PowerPoint, and Word.
Strong interpersonal and communication skills.
Ability to work collaboratively with both internal and external resources.
Ability to take responsibility, prioritize tasks and follow through to completion.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS  (include special requirements, e.g., lifting, travel)  :
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.
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.
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.
Scam alert   : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.
Req ID:    R8273

Job Summary Under the supervision of the Director of Data and Reporting, this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state agencies. The individual will handle internal data reconciliations and data transfers between Point32Health and external stakeholders such as vendors and provider organizations. This role requires strong analytical skills and the ability to synthesize large data sets and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow complex business processes, consider options when problems arise, and identify and escalate issues appropriately. Key Responsibilities/Duties – what you will be doing Data Submission Integrity <ul><li> Support the director across a range of activities, including monthly encounter data submission to the Executive Offices of Health and Human Services (RI and MA), CMS and APCD (All-Payer Claims Database) submissions to state agencies. </li><li> Monitor ongoing encounter data/APCDs response files to identify and address discrepancies in a timely manner. </li><li> Review monthly error reports, perform trend analysis, investigate critical errors, and work with the appropriate business area on resolution. </li><li> Enhance and automate existing reconciliation and reporting code using advanced SAS and/or SQL skills. </li><li> Interface with IT for the implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements, user acceptance testing, and post-implementation monitoring. </li></ul>  Reporting and Data Management <ul><li> Use Tableau, Cognos, and Excel to create monthly submission dashboards and run submission reconciliations to effectively track acceptance rates and submission trends. </li><li> Create various reconciliations and ad hoc reports. </li><li> Use SAS to extract and transform data to create reports from multiple sources. </li><li> Assist Strategy and Operations team with the implementation of new program vendors, including data file transfers and reviews of internally received files for completeness, reasonableness, and accuracy. </li><li> Establish and manage data transfer methods with vendors, including working with IT to set up and manage secure file transfer sites for vendors that support our risk adjustment programs. </li></ul> Collaboration with Internal/External Stakeholders <ul><li> Collaborate effectively within risk adjustment department and other internal stakeholders, including Claims, Member Operations, Information Technology, and Provider Information, to ensure that process enhancements and submission mechanisms are maintained and monitored. </li><li> Collaborate with federal agencies, vendor data management staff, and industry trade associations to stay up to date with changes and updates from EOHHS and other state agencies. </li><li> Effectively communicate regulatory updates to the team and department leadership and escalate risks appropriately. </li></ul>  Data Analysis <ul><li> Conduct ad hoc analyses specific to risk score trends, truncation report, data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups. </li><li> Create, compile, and format presentations for a variety of audiences, including supporting worksheets, graphics, and supplemental documents. </li></ul> Administration <ul><li> Attend meetings, document key decisions, manage follow up actions as necessary. </li><li> Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines. </li><li> Create and manage business policies and procedures and knowledge repositories for the department as needed. </li></ul>  QUALIFICATIONS – what you need to perform the job EDUCATION, CERTIFICATION AND LICENSURE: <ul><li> Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling. EXPERIENCE (minimum years required) : </li><li> Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm. </li><li> Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data sets preferred. </li></ul> <ul><li> Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated. </li><li> Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends. </li><li> Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL (SAS certification preferred). </li><li> Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos. </li><li> Experience with Alteryx, Cloudera and Tableau is a plus. </li><li> Proficient in Microsoft Excel, PowerPoint, and Word. </li><li> Strong interpersonal and communication skills. </li><li> Ability to work collaboratively with both internal and external resources. </li><li> Ability to take responsibility, prioritize tasks and follow through to completion. </li></ul>  WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel) : <ul><li> Must be able to work under normal office conditions and work from home as required. </li><li> Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. </li><li> May be required to work additional hours beyond standard work schedule. </li></ul> 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. 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. Scam alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law. Req ID: R8273

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