Senior Analyst, Government Programs Operations - Analysis & Efficiencies at Judi Health in Charlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United States

Job description

• The Senior Analyst, Government Programs Operations - Analysis & Efficiencies supports the operational success of Medicare, Medicaid, Exchange, and Commercial plans by developing data-driven solutions that improve efficiency, strengthen accuracy, and reduce manual effort.
• Under the guidance of the Operations Manager, the analyst evaluates complex datasets to identify actionable insights, inform strategic decisions, and drive continuous improvement.
• Key responsibilities include producing recurring and ad hoc reports, designing and implementing business intelligence dashboards, and creating standardized code templates to automate deliverables.
• The analyst also supports reversal and reprocessing (R&R) activities by conducting impact analyses, preparing supporting data, and validating post-fix and reprocessed results to confirm that expected outcomes are achieved.
• In partnership with Client Analytics, the analyst reviews and validates analytical outputs for accuracy, completeness, and alignment with business requirements before client delivery.
• The role also develops scalable, automated solutions that streamline workflows and collaborates with cross-functional teams—including Compliance, Product, Sales, Marketing, Underwriting, Implementation, Client Services, and Clinical Operations—to ensure analytical tools and operational capabilities align with regulatory requirements and business objectives

Responsibilities

• Analyze complex datasets to identify trends, outliers, and opportunities for operational improvement across Medicare, Medicaid, Exchange, and Commercial plans.
• Develop and maintain recurring and ad-hoc reports, dashboards, and analytical tools to support data-driven decision-making.
• Create and maintain a repository of standardized code templates to streamline report generation and automate routine tasks.
• Ensure analytical outputs align with applicable regulatory requirements and business objectives by interpreting CMS, state, Exchange, and Commercial requirements in partnership with internal subject matter experts.
• Support the development of scalable processes that enhance efficiency, accuracy, and responsiveness across Medicare, Medicaid, Exchange, and Commercial operations.
• Design and implement automated solutions to reduce manual effort and improve process scalability and accuracy.
• Implement and use analytical software to support the department in achieving goals as defined by executive leadership.
• Facilitate requirements-gathering sessions to understand business needs and translate them into actionable analytical deliverables.
• Analyze business workflows and system needs for conversions and migrations to ensure that encounter, recovery, cost-savings, and other applicable requirements are met.
• Support R&R activities by performing impact analysis, preparing supporting data, and evaluating expected member, client, financial, and operational impacts.
• Perform post-fix and post-reprocessing validation by comparing original and reprocessed outcomes, identifying variances, and confirming that implemented corrections produced the expected results.
• Present and communicate complex analytical findings in a clear and concise manner.
• Participate in user acceptance testing and quality assurance testing of new application features, system fixes, reprocessing activities, and team deliverables.
• Support root-cause analysis and reporting of claims, encounter, and other data issues or errors by partnering with key stakeholders; also provide operational support.
• Partner with Client Analytics to review and validate analytical outputs for accuracy, completeness, and alignment with business requirements prior to client delivery.
• Collaborate with cross-functional teams—including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations—to refine and enhance operational capabilities.

Requirements

• 4+ years of healthcare data experience supporting Medicare, Medicaid, Exchange, Commercial, or other health plan operations.
• 4+ years of experience working with SQL, R, or Python.
• 4+ years of experience performing analyses on large datasets, including impact analysis and validation of data before and after system fixes or reprocessing.
• Experience supporting reversal and reprocessing activities, claims adjustments, remediation efforts, or comparable operational correction processes.
• Knowledge of data management, statistics, and modeling concepts.
• Experience working with cross-functional teams.
• Experience with Tableau or other data visualization tools.
• Ability to balance multiple complex projects simultaneously.
• Extremely flexible, highly organized, and able to shift priorities easily.
• Attention to detail and commitment to delivering a high-quality work product.
• 4+ years of proven experience in government programs
• 3+ years of experience working with pharmacy data
• Experience with Medicare(Part D), Medicaid, and/or Marketplace Pharmacy Data/Processes

Skills

Required

• SQL
• R
• Python
• Data management
• Statistics
• Modeling concepts
• Cross-functional collaboration
• Project management
• Flexibility
• Organization
• Attention to detail

Preferred

• Government programs experience
• Pharmacy data experience

Benefits

• Denver, CO Salary Range
• Charlotte, NC Salary Range
• $82,000 - $102,500 USD