Value Based Care Analyst

Position Summary:

The Value-Based Performance Analyst supports the Medical Economics department through data analysis and performance reporting focused on provider performance, population risk trends, and value-based program outcomes across Community Care Plan products, including Medicaid and Marketplace.

This role is responsible for analyzing healthcare claims, encounter, and membership data to identify opportunities for improved provider performance, documentation accuracy, and population health outcomes. The analyst develops reporting and analytical insights used to support provider engagement efforts, value-based program initiatives, and population risk monitoring.

The position collaborates with internal analytics, clinical, and provider relations teams to translate complex healthcare data into actionable insights that support organizational decision-making and provider performance improvement. If you have experience with financial risk adjustment this is the prime position for you!

Essential Duties and Responsibilities:

• Analyze healthcare claims, encounter, and membership data to identify trends in utilization, cost drivers, provider performance, and population health outcomes across Medicaid and Marketplace populations.
• Develop and maintain analytical reports, dashboards, and data tools used to monitor provider performance, healthcare utilization patterns, and value-based program metrics.
• Evaluate population risk trends, disease burden, and documentation patterns that may impact healthcare outcomes and financial performance.
• Identify variations in provider performance and highlight opportunities for improvement based on analysis of healthcare data.
• Prepare provider-level performance reports and analytical summaries to support provider engagement and performance improvement discussions.
• Participate in meetings with provider groups to review performance data, explain analytical findings, and respond to questions regarding performance trends.
• Support monitoring and evaluation of value-based payment arrangements by analyzing provider performance against defined quality, utilization, and financial metrics.
• Conduct ad hoc analyses to support Medical Economics initiatives, including evaluation of healthcare cost drivers, utilization trends, and population risk characteristics.
• Collaborate with analytics, clinical, and provider relations teams to ensure accurate interpretation and communication of healthcare performance data.
• Maintain data accuracy and integrity through validation, quality assurance processes, and ongoing monitoring of analytical outputs.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

Required:

• Bachelor’s degree in Health Informatics, Healthcare Administration, Data Analytics, Economics, Public Health, or related field
• Minimum 3 years of healthcare analytics experience
• Strong proficiency in SQL, Excel, and data analysis tools
• Experience working with healthcare claims, encounter, or clinical datasets

Preferred:

• Experience working with Medicaid or ACA Marketplace health plan data
• Knowledge of Marketplace risk adjustment methodology or population risk scoring models
• Experience supporting value-based payment programs or provider performance initiatives
• Experience developing provider performance reports or dashboards

Skills and Abilities:

• Strong analytical and quantitative skills
• Ability to interpret complex healthcare data and identify actionable insights
• Effective written and verbal communication skills
• Ability to present data clearly to technical and non-technical audiences
• Strong attention to detail and data validation practices
• Ability to manage multiple analytical projects simultaneously

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Background Screening Notice:

In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at:

🔗 hhttps://info.flclearinghouse.com