Data Analyst

Who We Are

Point
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Health is a leading not‑for‑profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. Serving nearly 2 million members, Point
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Health 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.

Point
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Health is currently seeking highly motivated individuals to join our organization as an Analytics & Triage Fraud Analyst within our Special Investigations Unit (“SIU”). The Analytics & Triage Fraud Analyst is an essential team member of the SIU, responsible for analyzing claim trends, patterns and outliers, developing and refining queries to detect potentially fraudulent claim submissions and performing initial background on newly identified leads.

• Demonstrate strong business problem comprehension by developing analytic use cases (Who? What? Why?) that accurately capture business needs.
• Use programming and analytical skills to address analytic use cases, applying statistics where appropriate.
• Appropriately apply visualization best practices and data storytelling techniques.
• Apply a high level of QA rigor, proactively leveraging external validation sources and peer review.
• Develop documentation and methodologies for analyses and deliverables.
• Deliver a clear and concise presentation of findings to business owners and peers, tailoring the presentation to the audience.
• Monitor business adoption and utilization of analytic output, and solicit business feedback.
• Demonstrate problem solving aptitude through critique of analytic methodologies and studies completed by peers and third parties.
• Exemplify the characteristics of a lifelong learner, consistently seeking additional training and building knowledge/experience of business acumen, tools, languages and data sources.
• Act as a Lean Thinker, applying continuous improvement philosophies and approaches to identify and address inefficiencies in your day‑to‑day work.
• Meet assigned timelines and escalates risks/barriers as needed.
• Perform other duties as assigned.
• Perform analytical troubleshooting, capability building and ad hoc requests of monthly provider claims files, including communication with external stakeholders.
• Support the activities of a cross‑functional team charged with the following objectives: produce standard reporting and analytics for risk‑based providers; generate hypotheses for provider medical cost trends and quality performance; initiate analyses designed to test trends, understand performance variability (at a group and physician level), and suggest opportunities for performance improvement.
• Act as a liaison between corporate stakeholders and the IT department to ensure transparency and timely communication of questions or issues.
• Perform ad hoc analyses as required based on provider inquiries and internal business needs.

• Bachelor’s degree in an analytics‑related field.

• 3‑5 years of experience, preferably in a payer/provider setting.

• Moderate to complex analytics experience.
• Applied statistical experience.
• Visualization best practices and data storytelling methods.
• Intermediate programming skills (e.g., SAS, SQL, R, Python).
• Tableau or similar data visualization tool development experience preferred.
• Experience with health insurance claims data preferred.
• Demonstrated ability to manage tasks independently, take ownership of responsibilities and meet deadlines.
• Strong written and oral communication skills.

• Must be able to work under normal office conditions and work from home as required.
• Work may require…