L.A. Care Health Plan · 20 hours ago
Solutions and Data Analyst III
Los Angeles, CA
Full-time
Onsite
Senior Level
$102K/yr - $163K/yr
5+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, dedicated to providing health coverage to low-income residents of Los Angeles County. The Solutions and Data Analyst III role focuses on designing and operationalizing advanced analytic solutions to drive strategic insights and improve organizational performance through data analysis and reporting.
FitnessGovernmentHealth Care
Responsibilities
Designs and maintains reusable analytic data models and Extract, Transform, and Load (ETL) pipelines that support recurring insight generation and performance monitoring
Leads development of advanced dashboards, reports, and analytic tools that surface trends, correlations, and performances opportunities across enterprise domains
Partners with analysts, data scientists, and operational stakeholders to embed insights directly into workflows and decision processes
Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
Ensures adherence to data lineage, governance, and reproducibility standards across all analytic products
Supports enterprise level measure refresh cycles and ensures alignment with standardized data abstraction layers
Drives continuous enhancement of the analytic ecosystem by integrating new data sources, improving data structures, and optimizing performance
Translates analytic findings into business relevant narratives and partners with stakeholders to act on insights
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
Performs other duties as assigned
Qualification
Required
Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
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 KPIs (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights
Experience supporting initiatives to optimize cost, access, and quality within provider networks
Experience analyzing provider networks, including contracting, credentialing, and panel optimization
Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning
Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring
Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores
Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines)
Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations
Experience analyzing medical cost drivers across populations, conditions, and service types
Experience developing dashboards or analytic tools to monitor and optimize medical spend
Knowledge of claims, provider, and condition level analyses to support financial and operational decision making
Ability to identify high-cost services, utilization patterns, and opportunities for cost containment
Bachelor's Degree
At least 5 years of progressive analytics experience in healthcare, managed care, or related industries
Proven experience designing, developing, and operationalizing analytic solutions across multiple domains
Ability to operate with high autonomy, manage complex or ambiguous projects, and influence operational or strategic decisions
Experience translating multi-domain analytics into actionable insights for leadership and enterprise-wide initiatives
Demonstrated successful experience in communicating insights effectively to senior leadership and executives
Expertise in designing, building, and maintaining complex ETL pipelines and analytic data models that support enterprise reporting, dashboards, and predictive insights
Advanced experience with BI tools (Tableau, Power BI) to design insight rich, production ready dashboards and analytic products
Proficiency with SQL and/or Python/R for large-scale data manipulation, advanced analyses, and operationalization of analytic workflows
Strong knowledge of version control (Git/GitHub) and CI/CD processes for analytic code and pipelines
Ability to integrate, optimize, and enhance multiple data sources for performance, governance, and reproducibility
Ability to apply advanced statistical, predictive, and diagnostic methods to uncover drivers of quality, efficiency, and financial outcomes
Deep understanding of managed care operations, such as capitation models, provider networks, utilization management, and quality incentive programs
Ability to translate multi-domain data into actionable insights that directly inform strategic and operational decisions
Ability to conduct root-cause analyses, scenario modeling, and complex problem solving with minimal guidance
Ability to operate with high autonomy, independently defining priorities and managing complex, ambiguous analytic projects
Ability to communicate complex analytic findings effectively to senior leadership, executives, and external stakeholders
Ability to translate insights into actionable recommendations and strategic narratives that influence enterprise decision making
Ability to mentor and guide other analysts, promoting analytic best practices across teams
Ability to drive continuous improvement of analytic tools, data structures, and reporting ecosystems, proactively identifying opportunities to enhance organizational performance
Experience analyzing call center operations, enrollment services, and appeals & grievances
Experience translating data into actionable insights to improve member experience and member engagement operations
Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools
Ability to assess member touchpoints, satisfaction metrics, and operational KPIs
Experience analyzing community supports, care management, health education, Managed Long Term Support Services (MLTSS), and intervention programs
Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs
Knowledge of population health management frameworks and social determinants of health
Ability to evaluate population level outcomes and operational performance metrics
Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains
Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies
Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards
Experience analyzing appointment timeliness, access, and provider availability
Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling
Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring
Knowledge of access measurement frameworks and regulatory requirements
Ability to evaluate member access metrics, network capacity, and operational performance
Experience supporting enterprise level KPI maintenance, cross-domain dashboards, and measure ROI analyses
Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring
Knowledge of analytics frameworks, governance standards, and enterprise reporting processes
Ability to develop analytic tools and dashboards that consolidate insights across multiple domains
Preferred
AAPC Certified Risk Adjustment Coder (CRC®)
Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™)
NAMAS Certified HCC Coder (CHCC™)
AHIMA Certified Coding Specialist (CCS®)
Experience with enterprise level initiatives, such as Key Performance Indicator (KPI) maintenance, cross-domain dashboards, measure ROI, or strategic investment analytics
Strong experience managing care operations, including capitation, provider networks, risk adjustment, or quality incentive programs
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
Snowflake SnowPro Core Certification
SQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)
Python Institute PCEP™ or PCAP™ (Python Programming)
SnowPro® Specialty: Snowpark Certification
DataCamp Certified Data Analyst (Python or R)
HarvardX or Johns Hopkins Data Science Certificate (R)
Certified Health Data Analyst (CHDA)
Managed Care Professional (MCP) or relevant certification
Certified Analytics Professional (CAP)
Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM
Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS)
Experience supporting provider focused incentive program analytics
Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives
Certified Professional in Healthcare Quality (CPHQ)
Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Company
L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A.
1001-5000 employees
H1B Sponsorship
L.A. Care Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2023 (1)
2021 (3)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Melanie Rainer
Chief Strategy and Transformation Officer
Recent News
MarketScreener
2025-08-27
2025-08-04
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