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Sacramento, CA, USA
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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
Any Graduate
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