Senior Healthcare Business Data Analyst

About Totally Tech Totally Tech LLC is a technology solutions provider specializing in the development, implementation, integration, and support of digital platforms and enterprise solutions. We work with organizations across various industries to deliver technology-driven solutions that enhance operational efficiency, streamline business processes, and enable effective data management. About the Role We are looking for an experienced and Analytical Senior Healthcare Business Data Analyst to join our team. The successful candidate will play a key role in analyzing healthcare and medical insurance data, evaluating business and operational performance, monitoring system integrations, and delivering actionable insights to support strategic decision-making. This role requires a strong combination of healthcare and insurance industry knowledge, advanced data analytics capabilities, and experience working with integrated digital systems. The candidate will work closely with software development teams, project managers, insurance companies, healthcare providers, and other stakeholders to translate business requirements into analytical solutions, improve operational workflows, and ensure data accuracy across integrated systems. Key Responsibilities 1. Healthcare Business Intelligence & Operational Analytics. • Monitor and evaluate system utilization and transaction patterns across insurance companies, third-party administrators (TPAs), hospitals, clinics, diagnostic centers, and pharmacies. • • Analyze transaction volumes, integration performance, turnaround times, and adoption rates across different stakeholders. • • Identify trends in healthcare consumption, claims frequencies, medical costs, insurance utilization, and transaction patterns. • • Evaluate operational performance indicators and identify inefficiencies and improvement opportunities. • • Translate complex healthcare and insurance data into meaningful business insights and recommendations. 2. Healthcare Insurance & Claims Analysis • Analyze end-to-end medical insurance workflows, including eligibility verification, pre-authorization, claims submission, adjudication, payment processing, and dispute management. • • Evaluate insurance company systems, workflows, and data exchange processes with healthcare provider systems. • • Analyze claims data to identify discrepancies, rejection patterns, unusual billing activities, and operational inefficiencies. • • Review healthcare coding systems, including ICD diagnosis codes, CPT/ACHI procedure codes, and pharmaceutical classifications. • • Identify unusual transaction patterns, duplicate claims, potential billing anomalies, and over-utilization indicators. • • Recommend improvements to claims processing, transaction accuracy, and communication between insurance companies and healthcare providers. 3. Advanced Data Analytics & Business Intelligence • Develop and execute complex SQL queries to retrieve, consolidate, and analyze large datasets. • • Design, develop, and maintain business intelligence dashboards and executive reporting solutions. • • Define and monitor key performance indicators (KPIs), service level agreements (SLAs), and operational benchmarks. • • Conduct advanced data analysis to identify trends, forecast operational performance, and support business planning. • • Establish data quality standards, validation procedures, and reporting methodologies. • • Ensure consistency, accuracy, and reliability across integrated data sources. 4. System Integration & Technical Business Analysis • Monitor data exchange and transaction flows between healthcare providers, insurance companies, TPAs, and other integrated systems. • • Investigate integration issues, data discrepancies, transaction failures, and communication errors. • • Lead the gathering, analysis, and documentation of business and operational requirements. • • Oversee business-level data validation and participate in integration testing and user acceptance testing (UAT). • • Collaborate with software developers, solution architects, project managers, and technical support teams. • • Identify opportunities to improve system workflows, automate reporting activities, and optimize operational processes. 5. Stakeholder Management & Team Leadership • Present analytical findings, performance reports, and strategic recommendations to senior management. • • Coordinate with insurance companies, healthcare providers, and other business partners to address operational challenges. • • Act as a liaison between business stakeholders and technical teams to ensure alignment of business requirements with technical solutions. • • Mentor and guide junior analysts, review their work, and support their professional development. • • Provide analytical support for project planning, implementation, system enhancements, and ongoing operations. Qualifications & Experience Bachelor's or Master's degree in Health Informatics, Healthcare Administration, Data Analytics, Computer Science, Information Systems, Biostatistics, Business Analytics, or a related field. 6 –7 years of relevant professional experience in healthcare data analysis, medical insurance operations, health informatics, business intelligence, or a related field. Proven experience working with medical insurance systems, healthcare claims processing, pre-authorizations, and insurance workflows. Strong understanding of the operational relationship between insurance companies, TPAs, hospitals, clinics, and other healthcare providers. Practical experience working with integrated software systems, data exchange processes, or digital platform implementation projects. Demonstrated experience leading analytical initiatives, managing stakeholder requirements, and presenting findings to senior management. Technical & Analytical Skills • Advanced knowledge of SQL and relational databases. • • Strong experience developing dashboards and reports using Power BI or equivalent business intelligence tools. • • Strong understanding of healthcare transactions, medical insurance claims lifecycles, billing processes, and healthcare coding concepts. • • Understanding of APIs, data exchange mechanisms, system connectivity, and integration workflows. • • Experience establishing data validation frameworks and maintaining data quality. • • Strong analytical, quantitative, and problem-solving skills. • • Ability to translate business requirements into analytical specifications and system improvement recommendations. Industry Knowledge & Preferred Experience • Strong familiarity w

Key Responsibilities 1. Healthcare Business Intelligence & Operational Analytics. Monitor and evaluate system utilization and transaction patterns across insurance companies, third-party administrators (TPAs), hospitals, clinics, diagnostic centers, and pharmacies. Analyze transaction volumes, integration performance, turnaround times, and adoption rates across different stakeholders. Identify trends in healthcare consumption, claims frequencies, medical costs, insurance utilization, and transaction patterns. Evaluate operational performance indicators and identify inefficiencies and improvement opportunities. Translate complex healthcare and insurance data into meaningful business insights and recommendations. 2. Healthcare Insurance & Claims Analysis Analyze end-to-end medical insurance workflows, including eligibility verification, pre-authorization, claims submission, adjudication, payment processing, and dispute management. Evaluate insurance company systems, workflows, and data exchange processes with healthcare provider systems. Analyze claims data to identify discrepancies, rejection patterns, unusual billing activities, and operational inefficiencies. Review healthcare coding systems, including ICD diagnosis codes, CPT/ACHI procedure codes, and pharmaceutical classifications. Identify unusual transaction patterns, duplicate claims, potential billing anomalies, and over-utilization indicators. Recommend improvements to claims processing, transaction accuracy, and communication between insurance companies and healthcare providers. 3. Advanced Data Analytics & Business Intelligence Develop and execute complex SQL queries to retrieve, consolidate, and analyze large datasets. Design, develop, and maintain business intelligence dashboards and executive reporting solutions. Define and monitor key performance indicators (KPIs), service level agreements (SLAs), and operational benchmarks. Conduct advanced data analysis to identify trends, forecast operational performance, and support business planning. Establish data quality standards, validation procedures, and reporting methodologies. Ensure consistency, accuracy, and reliability across integrated data sources. 4. System Integration & Technical Business Analysis Monitor data exchange and transaction flows between healthcare providers, insurance companies, TPAs, and other integrated systems. Investigate integration issues, data discrepancies, transaction failures, and communication errors. Lead the gathering, analysis, and documentation of business and operational requirements. Oversee business-level data validation and participate in integration testing and user acceptance testing (UAT). Collaborate with software developers, solution architects, project managers, and technical support teams. Identify opportunities to improve system workflows, automate reporting activities, and optimize operational processes. 5. Stakeholder Management & Team Leadership Present analytical findings, performance reports, and strategic recommendations to senior management. Coordinate with insurance companies, healthcare providers, and other business partners to address operational challenges. Act as a liaison between business stakeholders and technical teams to ensure alignment of business requirements with technical solutions. Mentor and guide junior analysts, review their work, and support their professional development. Provide analytical support for project planning, implementation, system enhancements, and ongoing operations.