Description

Job description:

Primary Responsibilities

· Build and maintain T-SQL views, stored procedures, and operational reports (SSRS or equivalent) using data from the HealthRules Payer data warehouse replicated to on-premises SQL Server

· Develop and maintain data marts to support commercial health plan analytics, including:

o Claims lag and denial rates

o Financial accuracy and reconciliation

o PMPM trends

o Provider performance metrics

· Support ad-hoc and recurring data requests from finance, operations, compliance, and leadership teams

· Ensure data quality, consistency, and reconciliation between HealthRules data warehouse and downstream reporting layers

· Provide limited support for value-based care analytics, working within an existing enterprise semantic model that integrates:

o Health plan data

o Clinical data

o Quality and performance data

Required Skills & Experience

· 3+ years of experience developing solutions in SQL Server using:

o T-SQL

o SSRS

o SSIS

· Experience working in a healthcare payer or provider environment

· Strong knowledge of HealthRules Payer data warehouse structures, including:

o Claims

o Membership

o Provider

o Accumulators

· Experience with commercial health plan metrics and KPIs, including:

o Claims processing

o Enrollment

o Accumulators

o Financial and operational reporting

· Experience building data marts or semantic layers to support reporting and self-service BI

· Hands-on experience with Power BI, including working within existing datasets and semantic models

Preferred Qualifications

• Understanding of health plan regulatory reporting (e.g., risk adjustment, MLR, quality measures)

• Experience with value-based care analytics (quality measures, cost of care, utilization, risk stratification)

• Experience working with multi-source data models integrating payer, clinical, and quality data

Key Skills

Education

Any Graduate