Healthcare Data Analyst / SME - Value-Based Care (VBC) & Claims Analytics

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Role:Healthcare Data Analyst / SME – Value-Based Care (VBC) & Claims Analytics

Location: Pleasanton, CA

VIsa: H1B, EAD

Experiance: 12+ years

Role Overview:

Seeking a Healthcare Domain Subject Matter Expert (SME) / Data Analyst with strong expertise in Claims Analytics, Milliman MedInsight, and Value-Based Care (VBC). The role focuses on analyzing complex healthcare datasets, delivering actionable insights, and supporting reporting, operations, and decision-making in a fast-paced environment.

Key Responsibilities:

• Act as SME for healthcare analytics, focusing on Value-Based Care models (shared savings, capitation, quality metrics)
• Analyze claims, provider, member, and eligibility data to identify trends, cost drivers, and performance gaps
• Translate business requirements into analytical solutions and functional specifications
• Perform data analysis using Databricks (SQL, notebooks) and deliver actionable insights
• Develop ad-hoc and recurring reports using Power BI and analytics tools
• Validate data accuracy, anomalies, and quality metrics across multi-source datasets
• Support ServiceNow (SNOW) ticket triage, root cause analysis, and issue resolution
• Investigate claims discrepancies, processing issues, and business rule validations
• Collaborate with business, clinical, and technical stakeholders to align data outputs with business goals
• Communicate insights effectively to technical and non-technical audiences

Required Qualifications:

• Strong Healthcare domain expertise: Claims data, provider reimbursement, healthcare operations
• In-depth knowledge of Value-Based Care (VBC) and performance measurement
• Hands-on experience with Milliman MedInsight (Claims Analytics Platform)
• Strong SQL and data analysis skills for large, complex datasets
• Experience with Databricks environment (data exploration, notebooks, analytics)
• Ability to perform root cause analysis and translate data into business insights
• Experience supporting ad-hoc reporting and analytical requests
• Strong problem-solving, critical thinking, and communication skills

Preferred Qualifications

• Experience with payer, provider, or population health analytics
• Exposure to quality metrics, cost-of-care, utilization, and risk adjustment analytics
• Familiarity with data warehouses and reporting tools (Power BI)
• Experience with ServiceNow for incident and ticket management

Skills & Tools:

• Domain: Healthcare Analytics, Claims, Value-Based Care (VBC)
• Platforms: Milliman MedInsight, Databricks
• Data & Querying: SQL, Data Analysis, Data Validation
• Reporting: Power BI
• Tools: ServiceNow (SNOW)
• Core Skills: Business Analysis, Stakeholder Management, Problem Solving, Data Interpretation