Healthcare Economics Data Analyst II
Clever Care Health Plan · Huntington Beach Office - Huntington Beach, CA 92647 · hybrid
This position operates on a hybrid work schedule. This position will require 3 days onsite at the Huntington Beach office.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us? 🏆
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The Healthcare Economics Data Analyst II independently conducts moderately complex analyses across medical claims, pharmacy, membership, risk adjustment, quality, and population health. The analyst owns recurring deliverables and defined analytical projects, identifies cost, utilization, revenue, quality, and member-health opportunities, and translates findings into practical recommendations for business and clinical partners.
Functions & Job Responsibilities
- Independently design and complete moderately complex analyses of cost, utilization, unit cost, service mix, pharmacy spend, membership, risk scores, quality performance, and population health outcomes.
- Own recurring dashboards, scorecards, worklists, and reporting packages from data extraction through validation, interpretation, and delivery.
- Develop reusable SQL queries, data models, business rules, and automated reporting processes that improve timeliness and consistency.
- Perform drill-down analyses by provider, medical group, product, region, risk type, member segment, diagnosis, procedure, and site of care.
- Support risk adjustment financial analytics, including RAF trend, suspect and recapture opportunity, coding pattern, submission status, and intervention performance.
- Support Stars/Quality analyses involving measure performance, care gaps, provider variation, intervention targeting, and outcome tracking.
- Develop population health cohorts, risk stratification, chronic-condition prevalence, avoidable-utilization, outreach prioritization, and pre/post program evaluations.
- Evaluate care management, pharmacy, quality, vendor, and culturally attuned benefit programs using utilization, engagement, outcome, satisfaction, and financial measures.
- Investigate data anomalies, reconcile multiple sources, assess limitations, and recommend corrective action.
- Present findings and recommendations to managers and cross-functional partners; contribute to executive-ready materials.
- Gather requirements, define metrics, manage project timelines, and communicate risks or dependencies.
- Provide peer review and technical guidance to Level I analysts.
- Maintain compliance with HIPAA, CMS, corporate, and departmental requirements.
- Perform other duties as assigned.