Location:
1900 Aldrich Street
Austin, Texas, 78723
United States
Health Insurance Data Analyst or Senior
| Requisition ID: |
req1205 |
Employment Type: |
Unclassified Regular Full-Time (URF) |
| Division: |
Health Finance |
Compensation: |
73,790.00 - 92,237.00, Annual Salary |
| Location: |
Alpha Building |
Job Closing: |
4/11/2025 5:00pm |
WHO WE ARE:
With the Health Division, you’ll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators.
The healthcare industry is complex and we’re a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members’ lives. With a career at TRS, you’ll be empowered through a culture of continuous learning, front-line decision-making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 47 Texans.
The Health Insurance Data Analyst performs mid-level health insurance plan management work to ensure the plan is running efficiently, benefits are being administered appropriately, and to promote the long-term stability of the health insurance plans.
The position involves analyzing healthcare data and reporting, monitoring the performance of plan administrators, and assisting with procurement and contract documents. This role requires solid analytical, communication, writing and project coordination skills, with opportunities to develop leadership capabilities while contributing to initiatives that enhance health plan efficiency and performance.
The Senior Health Insurance Data Analyst performs complex health insurance plan management work to ensure the plan is running efficiently, benefits are being administered appropriately, and to promote the long-term stability of the health insurance plans.
The position involves conducting and synthesizing healthcare data analyses and research, monitoring and evaluating the work of plan administrators, leading and developing procurement and contract documents, and providing actionable insights for improvement. The ideal candidate will excel in directing and overseeing the work of diverse teams, including internal staff, consultants, and vendors, to ensure effective collaboration and successful project outcomes. This role requires strong analytical, communication, writing and project management skills, and the ability to drive initiatives that enhance plan efficiency and performance.
This position is posted at two levels - Health Insurance Data Analyst and Senior Health Insurance Data Analyst. Selected candidate will be offered the position that most closely matches their education and experience.
Salary range
Health Data Analyst : $73,790 - $92,237 annually
Senior Health Data Analyst : $89,286 - $111,608 annually
WHAT YOU WILL DO:
Health Insurance Data Analyst
Research and Data Analysis
• Performs healthcare data analyses to support plan performance evaluations and identify key trends.
• Develops SQL queries in the data warehouse to extract claim data for use in analyses and dashboards.
• Assists in synthesizing data into clear and concise analyses and dashboards to inform decision-making and drive improvements.
Vendor Management
• Reviews and validates routine vendor reports on health plan performance and ensure adherence to contractual obligations.
• Solicits, collects, and reports on regular feedback from Health staff relating to vendor performance.
• Addresses minor vendor performance issues with guidance from senior team members.
• Assists in reconciling financial guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
Procurement and Contracting
• Participates in market research and support procurement activities to assess and implement services.
• Collaborates with internal stakeholders to draft sections of procurement documents and assist in their timely completion.
• Drafts routine contract amendments and executive memos outlining contractual improvements under the guidance of senior team members.
Health Plan Management
• Assists in developing recommendations for improving plan performance and cost containment.
• Provides support for internal and external audits, and track resolutions.
• Tracks legislative bills and provide support for fiscal note analyses.
• Participates in the development of department policies and procedures
• Performs related work as assigned.
Senior Health Insurance Data Analyst
Research and Data Analysis
• Conducts in-depth research and analysis of health care data to evaluate plan performance, identify trends, and develop actionable insights.
• Synthesizes data into clear and concise analyses to inform decision-making and drive improvements.
• Utilizes data visualization tools and techniques to effectively present complex data to diverse audiences.
• Develops and automates SQL queries in our internal data warehouse to extract claim data for use in analyses and dashboards.
• Reviews reporting of health care data from external sources including from TRS' health care consultants, insurance companies, or other industry resources.
• Analyzes provider reimbursement levels, high-cost claims, costs by geographic area and place of service, and claim accuracy.
• Identifies enrollment and cost trends, cost-saving opportunities, and potential fraud, waste, and abuse.
• Analyzes claim data to support invoice processing.
Vendor Management
• Conducts regular assessments of vendor activities to evaluate performance based on good understanding of contracts and adherence to contractual obligations.
• Reviews and validates vendor reports on health plan performance.
• Reconciles financial guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
• Directs the work of vendors and monitor their progress on enacting TRS initiatives and information requests.
• Addresses and resolves non-compliance or subpar performance issues with vendors and escalates issues appropriately.
• Leads meetings with vendors and manage agenda items.
Procurement and Contracting
• Conducts market research to assess the products, services, and viability of companies that could potentially enhance TRS’ services.
• Collaborates with internal stakeholders within the Health, Purchasing, and Legal & Compliance divisions, as well as with consultants to develop technical requirements, scopes of work, evaluation criteria, and procurement documents.
• Acts as project manager to ensure procurement documents are produced timely and according to project workplans.
• Negotiates contract renewal terms, requirements, and improvements.
• Drafts business-need based solicitation documents
• Analyzes submissions/proposals from vendors and summarize responses.
Health Plan Management
• Communicates with stakeholders related to plan performance and initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends.
• Recommends and implements strategies to optimize benefit delivery, plan performance, cost containment, and clinical outcomes.
• Collaborates with internal and external auditors to conduct claim and vendor performance audits; track all audit findings through resolution.
• Reviews legislative bills and provide fiscal note analyses. Implement bills that become law.
• Supports the development of department policies and procedures.
• Provides training to new team members and to the Health division.
• Performs related work as assigned.
WHAT YOU WILL BRING:
Required Education
• Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field.
• High school diploma or equivalent and additional full-time experience in health plan administration, health data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year-for-year basis.
Required Experience
• Three (3) years of full-time directly related, progressively responsible experience in analyzing health care claims data, health financial data, administration of a health insurance plan or similarly related experience. (Analyst)
• Five (5) years of full-time directly related, progressively responsible experience in analyzing and visualizing health care claims data, health financial data, administration of a health insurance plan or similarly related experience. (Senior)
• A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis.
Preferred Qualifications
• Advanced degree in actuary science, finance, mathematics, statistics, business, health care administrations, or closely related field.
• Recent experience in health plan administration or consulting, pharmacy benefits, actuarial services, business finance, claim auditing, procurement and contracting.
• CEBS Certification
• CTCM Certification within 6 months of hire.
Knowledge of
• Data analysis concepts and methods, including education equivalent to at least statistics for business, health benefit claims processing, Medicare, coordination of benefits, standard medical procedures, and billing.
• Health care claims data including CPT, HCPCS, DRG, ICD-10, and NDC.
• Health care related laws, regulations, policies and procedures.
• Self-funded and fully insured group health benefit products and contracts, including Medicare Advantage.
• Provider networks, contracts, plan operations and systems.
• Healthcare systems and clinical concepts.
Skill in
• SQL to query data and other tools such as R or Python.
• Researching, compiling and analyzing complex data.
• Managing projects, including planning, organizing, and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment.
• Interpreting and applying complex laws, regulations, policies, and procedures.
• Completing detailed work with a high degree of accuracy.
Ability to
• Meet frequent and multiple deadlines, manage conflicting priorities and demands, and adapt to changes in schedules and assignments.
• Think critically, analyze problems, evaluate alternatives, and proactively recommend effective solutions.
• Communicate effectively and maintain harmonious working relationships with co-workers, agency staff, vendors and other external contacts and to work collaboratively in a professional team environment.
Military Occupational Specialty (MOS) Codes:
Veterans, Reservists or Guardsmen with experience in the Military Occupational Specialty (
https://www.trs.texas.gov/files/trs-military-crosswalk.xlsx
) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply. Please contact Talent Acquisition at
careers@trs.texas.gov
with questions or for additional information.
To view all job vacancies, visit www.trs.texas.gov/careers
or www.trs.csod.com/careersite.
For more information, visit www.trs.texas.gov.
