Senior Analyst, Government Programs Operations - Analysis & Efficiencies

Position Summary: 

The Senior Analyst, Government Programs Operations - Analysis & Efficiencies will play a pivotal role in supporting the operational success of Medicare, Medicaid, and the Exchange programs. This analyst develops data-driven solutions that enhance efficiency and reduce manual efforts. Under the guidance of the Operations Manager, this analyst utilizes complex datasets to identify actionable insights that inform strategic decisions and drive ongoing improvement. The analyst’s responsibilities encompass delivering recurring and ad-hoc reports, designing and leading the implementation of BI dashboards, and creating standardized code templates to automate deliverables. Additionally, the analyst contributes to process optimization by designing scalable, automated solutions that streamline workflows and minimize manual intervention. Collaboration with cross-functional teams, including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations, is crucial to ensure that analytical tools and operational capabilities align with both regulatory requirements and business objectives.

Position Responsibilities: 

• Analyze complex datasets to identify trends, outliers, and opportunities for operational improvement across Medicare, Medicaid, and Exchange programs

• Develop and maintain recurring and ad-hoc reports, dashboards, and analytical tools to support data-driven decision-making

• Create and maintain a repository of standardized code templates to streamline report generation and automate routine tasks

• Ensure analytical outputs align with regulatory requirements and business objectives by interpreting CMS and state guidance in partnership with internal subject matter experts.

• Support the development of scalable processes that enhance efficiency, accuracy, and responsiveness across government program operations

• Design and implement automated solutions to reduce manual effort and improve process scalability and accuracy

• Implements and uses analytical software to support the department in achieving goals as defined by executive leadership

• Facilitate requirements gathering sessions to understand business needs and translate them into actionable analytical deliverables

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met

• Presents and communicates complex analytical findings in a clear and concise manner

• Participates in user acceptance, and quality assurance testing of new application features and team deliverables

• Supports root-cause-analysis and reporting of encounter data issues/errors by partnering with key stakeholders – Will also provide operationally support

• Prepares high-level user documentation and training materials as needed

• Work with internal and external clients to research, develop, and document new standards to enhance reporting capabilities

• Collaborate with cross-functional teams—including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations—to refine and enhance operational capabilities

• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Required Qualifications:

• 4+ years of healthcare data experience

• 4+ years of experience working with SQL, R, or Python

• 4+ years of experience working with business intelligence tools

• Experience performing analyses on large sets of data

• Knowledge of data management, statistics, modeling concepts

• Experience working with cross-functional teams

• Experience with Power BI or other data visualization tools

• Ability to balance multiple complex projects simultaneously

• Extremely flexible, highly organized, and able to shift priorities easily

• Attention to detail & commitment to delivering high-quality work product

• Bachelor's degree in Business Administration, Data Analytics or 4+ years of relevant experience

Preferred Qualifications:

• 4+ years of proven experience in government programs

• 3+ years of experience working with pharmacy data

• Experience with Medicare(Part D), Medicaid, and/or Marketplace Pharmacy Data/Processes