Point32Health

Point32Health

Sr Data Analyst

Canton, MA · Senior

Sponsorship not specified$89k-$133kDetected 31 days ago
SQLDatabricksData EngineeringData VisualizationComplianceStakeholder ManagementExcelAuditingProcess ImprovementSASCommunicationCollaborationActuarial Science

About the role

  • This role is accountable for the completeness, accuracy, and timeliness of Point32Health's All‑Payer Claims Database (APCD) submissions across applicable markets, as well as supporting the encounter data submissions to Rhode Island EOHHS.
  • DUTIES/RESPONSIBILITIES - what you will be doing:
  • Serve as a subject‑matter expert for encounter and APCD data submission logic, providing guidance and recommendations to cross‑functional teams.

Responsibilities

  • Collaborate closely within the Risk Adjustment department and with cross‑functional partners including Claims, Member Operations, Information Technology, and Provider Information to ensure data submission processes and enhancements are effectively implemented and maintained.
  • Partner with IT to support timely resolution of production issues, ensuring alignment between business requirements and technical solutions.
  • Communicate findings, risks, and recommendations clearly to management and stakeholders to support informed decision‑making.
  • Attend internal and external (state‑led) meetings; document key decisions; and track and manage follow‑up actions through completion.
  • Develop, maintain, and update business policies, procedures, and knowledge repositories to support consistent operations, effective onboarding, and audit readiness.
  • Support RI EOHHS encounter data submissions, including error analysis, reconciliation, remediation, and end‑to‑end submission support.
  • Monitor and analyze encounter and APCD response files to identify rejections, discrepancies, and data quality issues; perform trend analysis and root‑cause investigations and drive timely resolution.
  • Partner with IT and data engineering teams on enhancements and production issue resolution, including requirements clarification, issue investigation, UAT, and post‑implementation validation.
  • Support encounter and APCD data readiness for risk adjustment, financial reconciliation, actuarial reporting, and regulatory audits.
  • Identify inefficiencies and improvement opportunities in monthly data submission, reconciliation, and tracking processes, and drive continuous improvement initiatives.

Requirements

  • Must be able to work under standard office conditions and from home as required.
  • May be required to work additional hours beyond the standard work schedule, as business needs dictate.
  • They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Nice to have

  • Required: Bachelor's degree required
  • master's degree preferred.
  • Understanding of claims systems, provider data, and Medicaid, Medicare, and commercial products preferred.
  • Prior experience with regulatory data submissions, including All‑Payer Claims Database (APCD) submissions, a plus.
  • Experience with SAS, Alteryx, Databricks, Tableau, and knowledge of X12 837, 277, and 835 EDI transactions a plus.

Compensation

  • $88,942.17 -$133,413.25
  • Compensation & Total Rewards Overview
  • The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.
  • The actual salary for this position will be determined by several factors, including the scope and complexity of the role
  • As part of our comprehensive total rewards program, colleagues are also eligible for variable pay.
  • Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Benefits

  • Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare.
  • Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
  • We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are.

Company info

  • Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background
  • it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
  • We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
  • Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions.
  • We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
  • Learn more about who we are at Point32Health.
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This listing is sourced directly from Point32Health's careers page and normalized into a canonical job model.