Analyst, Operations Performance - Jefferson Health Plan

Job Details

This role will analyze operational and claims data to produce reports, dashboards, and executive summaries that support performance management, regulatory reporting, and leadership decision-making at Jefferson Health Plans. The objective is to identify trends, anomalies, and opportunities for improvement across operations, while providing actionable insights that strengthen reporting accuracy, compliance, and overall business performance. Perform reasonable expectances, set performance standards, capacity modeling and forecasting, and assisting with Epic set up.

Job Description

• Utilize advanced SQL techniques (complex joins, subqueries, CTEs, pivots, ranking, and data mining) to extract, analyze, and validate operational data.
• Develop claim and operational data models to forecast financial impacts, identify issues, and support business initiatives.
• Design, automate, and maintain standardized weekly, monthly, and quarterly reports, dashboards, and executive summaries.
• Leverage SQL, Power BI, Excel, and other reporting tools to transform data into actionable insights for leadership and operational teams.
• Analyze operational and HP system data to identify processing anomalies, data integrity concerns, trends, and KPI performance drivers.
• Perform root cause analysis, statistical evaluations, and data validation to support informed decision-making and continuous improvement.
• Partner with stakeholders and quality teams to interpret findings, establish audit methodologies, and recommend process enhancements.
• Monitor business process performance, document and escalate significant fluctuations, and provide data-backed recommendations to management.
• Prepare and communicate reporting metrics for internal and external audiences, ensuring accurate performance tracking and executive visibility.
• Support system upgrades, project implementations, and ongoing reporting requirements while maintaining SQL scripts and performance-monitoring tool
• SQL Codes to access data for trending

 

 

Education and Experience

• Associate’s Degree Required
• Bachelor’s Degree Preferred
• 3 years experience Preferred

 

Knowledge, Skills and Abilities - Required

• Strong working knowledge of SQL, Power BI, and Excel required for data analysis, reporting, visualization, and performance monitoring.

 

Knowledge, Skills and Abilities - Preferred

• Excellent verbal and written communication skills, with the ability to explain complex data, trends, and statistical variances to diverse audiences.
• Strong interpersonal skills and ability to effectively collaborate with stakeholders at all levels of the organization.
• Proficiency in Microsoft Excel, Word, and Access; experience with data warehouses and statistical analysis tools preferred.
• Knowledge of claims and/or managed care operations preferred.
• Ability to work independently, manage multiple priorities, and deliver high-quality results within strict deadlines.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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