Role Description The Senior Consultant - Data Analytics & Network Evaluation supports client healthcare initiatives through advanced data analysis, solution engineering, and emerging data science methods. This role analyzes complex healthcare and claims data to identify trends, financial impacts, and network performance while developing scalable analytical models, dashboards, and predictive tools. The Senior Consultant evaluates carrier networks, benchmarks performance, and supports ROI and health economics modeling to inform client strategy and decision-making. Responsibilities include: - Collaborating with cross‑functional teams. - Ensuring data accuracy and integrity. - Translating complex analytics into clear insights for diverse audiences. - Acting as a technical expert on advanced data mining techniques. Success in this role requires: - Strong analytical expertise. - Effective communication skills. - Sound professional judgment. - The ability to thrive in a fast‑paced, collaborative environment. - Building client relationships and supporting team development. Qualifications - Bachelor’s degree (BS) in Mathematics, Actuarial Science, Statistics, Economics, or Computer Science. - 7+ years’ working experience as an Actuarial Analyst, Data Analyst, or Data Scientist in the HealthCare sector. - 5+ years of hands-on experience with structured query languages and statistical computing (e.g., R, RStudio, SQL, Python, SAS). - 3+ years of hands-on experience building and conducting ETL tasks. - Knowledgeable about applied statistics, experimental design, and machine learning techniques. - Expert with data mining and visualization tools such as Qlik, Tableau, or Power BI. - Experience with developing medical and pharmacy utilization reporting, establishing utilization trends, and identifying meaningful and actionable observations. - Experience with Uniform Discount and Data Specification (UDS) submissions is a plus. - Experience with underwriting insurance premiums is a plus. - Ability to generate information quickly and manage multiple projects at once. - Knowledge of conducting health statistical modeling for medical and pharmacy, ROI analyses, and indirect comparisons. - Diverse experience of healthcare databases and data sources (claims, encounters, labs, EMR etc.). - Extensive knowledge of healthcare/medical economics data such as hospital/physician/ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APC. - Strong analytical skills with the ability to collect, organize, analyze, conceptualize, problem solve, and disseminate information confidently and collaboratively with attention to detail, accuracy, timeliness. - Solid knowledge of business, financial, strategic concepts, and emerging trends. - Solid interpersonal skills, oral and written, and a professional presence. Requirements - Analyze complex healthcare data sets to identify trends, patterns, and insights. - Create and present reports, dashboards, and visualizations to communicate findings to stakeholders. - Isolate healthcare trend drivers and financial impacts associated with client medical claims, pharmacy claims, and other types of healthcare data. - Perform varying types of analysis including medical carrier network valuations, discount analysis, and benchmarking. - Leverage real-world, statistical data and modeling to recommend, test, validate, and track supporting health economics, return on investment (ROI), and healthcare benefit models for client businesses beyond traditional methods. - Develop analytical analytics, data models, reporting, and data mining tools that scale across clients. - Codevelop and implement data collection strategies, design, and maintain databases. - Conduct complex analyses adhering to best practice standards by selecting appropriate data sources, developing assumptions, recognizing considerations, and establishing recommendations. - Collaborate with cross-functional teams to define data requirements and ensure data accuracy and integrity. - Identify opportunities for process improvement and efficiency through data analysis. - Stay up-to-date with industry trends and best practices in data analysis. - Resolve unreasonable results, suboptimal solutions, and data anomalies based on experience and professional judgment. - Act as a technical expert and advise on strategic data mining techniques used to identify new relationships or patterns in data. - Consult and provide expertise on new or enhanced product development opportunities including discussions on methodology, data requirements, coding implications, and the viability and profitability of a given proposal. - Build predictive models to accurately analyze potential outcomes that are likely costs/savings for a given initiative or event(s). - Develop and maintain effective cross-functional working relationships to assure accurate, timely teamwork and project execution with assigned teams. - Translate, document, and present approaches, processes, and results of complex modeling and statistical analysis into layperson terms for diverse, internal and external audiences. - Build and maintain client relationships. - Monitor market trends, engage in market research, and identify opportunities for initiatives. - Support the development and training of team members and colleagues. - Participate in peer review of your own work as well as your colleagues. - Document all developed work with version controlling and logic documentation. Benefits - Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance. - Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement. - Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services. - Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.