Authorizations and Claims Analytics Solutions Business Insights and Data Analyst III

About L.A. Care Health Plan L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. As a publicly operated health plan, L.A. Care Health Plan serves more than 2.6 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on X, Facebook, LinkedIn, Instagram and YouTube. To learn more, visit www.lacare.org. *For urgent inquiries: 1-888-4LA-CARE (1-888-452-2273)

L.A. Care Health Plan

Elevating health care for all of L.A. County

HMOHealth Information TechnologyHealthcare Insuranceand Community Health

L

lacare.org

1,001-5,000 employees

Hospitals and Health Care

Los Angeles, California

1997

Nonprofit

40k LinkedIn followers

• The Authorizations and Claims Analytics Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance. This position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan.
• This position emphasizes the development of insight rich, production ready analytic assets, delivering repeatable, governed analyses that illuminate key drivers of care quality, efficiency, and financial outcomes.
• Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.   Duties
• 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.

Required

• Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
• 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.
• 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.
• Experience with Utilization Management (UM) authorization workflows and prior authorization metrics.
• 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.
• Ability to influence operational or strategic decisions. 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.

Preferred

• 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.Skills
• Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.Licenses/Certifications Required
• Tableau Certified Data Analyst or Tableau Desktop SpecialistSnowflake SnowPro Core CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Python Institute PCEP™ or PCAP™ (Python Programming)SnowPro® Specialty: Snowpark CertificationDataCamp 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)or relatedMicrosoft Certified: Data Scientist Associate (DP-100)Required Training

• Paid Time Off
• Tuition Reimbursement
• Retirement Plans
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Wellness Program
• Volunteer Time Off