JOB SUMMARY

Responsible for analyzing and translating complex provider network and operational data into actionable insights that support performance improvement and regulatory compliance. This role focuses on evaluating provider network adequacy, access to care, utilization trends, and operational workflows within a healthcare environment. The analyst will design and deliver reports, dashboards, and data visualizations to monitor key performance indicators, including provider availability, geographic access, case turnaround times (TAT), and provider onboarding metrics. This role partners closely with Provider Network, Operations, and Leadership to ensure data-driven visibility into network performance, support strategic decision-making, and continuous improvement initiatives aligned with healthcare regulations, best practices and standards.

ESSENTIAL FUNCTIONS

• Develops, maintains, and automates new reports, dashboards, and other means to enable transparency and monitor network management operational processes. Provides timely information to management regarding status of compliance with guidelines, rules-regulations and internal policies and procedures and assists with decision-making and tracking accountability. 
• Analyzes provider network adequacy, including geographic distribution, provider-to-member ratios, and compliance with access standards, such as time and distance requirements.
• Generates reports on provider availability and accessibility by specialty, region, and line of business.
• Evaluates provider utilization trends, including patterns by specialty, primary care providers (PCPs), and service areas.
• Monitors and reports on key operational metrics such as case volumes, turnaround times (TAT), provider onboarding timelines, and case closure rates.  Track and analyze provider-related interventions, outreach efforts, and network development activities to assess impact on access and performance.
• Ensures data integrity and consistency across multiple healthcare data sources, including claims, providers data, and operational systems. Monitors data quality and reliability and creates solutions to proactively address and resolve data quality inconsistencies.
• Supports compliance reporting and audits by ensuring accuracy and completeness of data related to provider networks and access to care.
• Prepares and responds Ad-Hoc reporting requests as needed for specific situations, such as other departments, auditors, and external regulators.
• Designs and delivers executive-level dashboards and presentations that communicate key trends, risks, and opportunities related to network performance.
• Translates complex healthcare data into clear, concise insights for technical and non-technical stakeholders.
• Continuously enhances reporting capabilities through automation, standardization, and implementation of data analytics best practices.

EDUCATION

EXPERIENCE

Bachelor’s degree in Biostatistics, Mathematic, Finance or related field, preferable, with one (1) to (3) three years of experience in the Health Insurance Industry preferred.  

LICENSES AND CERTIFICATIONS

COMPETENCIES