Health Data Analyst
The Health Data Analyst performs complex health care related research and analysis, reporting and program administration work. Work involves analyzing health care related data to support benefit decision-making and plan operations; developing and reporting key performance indicators related to health plan performance and administration; and analyzing claims data to ensure the optimal delivery of health care services among TRS' members. This position is located in downtown Austin and reports to the Health Analytics and Engagement Director in the Health Insurance & Benefits Department (HIB).
WHAT YOU WILL DO:
Research and Data Analysis
• Reviews and reports on health care claims, participant service utilization, and pricing to assist with HIB management decisions.
• Facilitates the interpretation of health care data from external sources including data from TRS health care consultants, insurance companies, or other industry resources.
• Analyzes detailed enrollment, claim, utilization and other health care related data to identify trends and anomalies, and to identify areas of action.
• Analyzes claim data to support actuarial analysis.
• Analyzes medical and pharmacy claims data to determine areas for greater integration among medical services and drug therapies and ensure the optimal delivery of health care services.
• Performs ad hoc analysis of population engagement trends, behavioral trends, health needs and patterns, high cost claims, and costs by geographic area and place of service to facilitate utilization management decisions.
• Works with vendors and external partners to carry out research related to the administration of TRS health plans.
• Develops responses to legislative requests including fiscal notes.
Development and Management of Reporting Tools
• Develops queries in TRS’ IBM Cognos database to extract data for use in spreadsheets, models, dashboards, and summaries that support decision-making.
• Researches, recommends, and implements methodologies for reporting health care data and statistics including key performance indicators for program activities.
• Analyzes cost and quality data to assess high-value health care providers and health plan performance.
• Works with Manager of Informatics and Communications and Information Analyst to identify data needed to develop reports, briefings, and presentations.
• Supports other areas of HIB (Finance and Operations) in analyzing program data and developing key performance indicators and dashboards as needed.
• Assists with evaluating HIB’s business needs related to reporting tools and assessing vendors proposals for data analysis services.
• Sets agenda for quarterly and annual meetings with health plan vendors.
• Assists with managing health care strategic plan.
• Communicates regularly with vendors to address questions related to data integrity, network updates, pharmaceutical changes, marketplace situations, and trends.
• Reviews federal and state legislation for applicability to and impact on TRS benefit programs.
• Assists in the preparation, development, review and/or revision of legislation.
• May assist with preparation professional papers or reports.
• Reviews and analyzes various routine vendor reports on a monthly, quarterly, and annual basis.
• Participates on special projects, task forces, and committees as needed.
WHAT YOU WILL BRING:
• Bachelor’s degree from an accredited college or university in accounting, finance, mathematics, statistics, business, health care administration, or a closely related field.
• High school diploma or equivalent and additional health care industry, benefits and/or health insurance claims processing, research, data and/or financial analysis, accounting, auditing or other directly related experience may substitute for the required education on a year-for-year basis.
• Advanced degree in actuary science, accounting, finance, mathematics, statistics, business, health care, health care administration, or closely related field may substitute for one year of the required experience.
Five (5) years of full-time experience in analyzing complex datasets such as health care claims data or financial data.
• Advanced degree in actuary science, accounting, finance, mathematics, statistics, business, health care administration, or closely related field.
• Two (2) years of full-time experience health care claims data and/or health insurance related data.
• Recent experience in actuarial services, business finance, accounting, or auditing.
• Experience processing or reviewing health insurance claims.