Senior Specialist, Provider Data Operations
Own insurance taxonomy policies, database health, quality standards, and process improvements for a healthcare marketplace. The role requires 5+ years of U.S. healthcare insurance experience, strong analytical skills, and cross-functional partnership with product, engineering, operations, and analytics teams.
About the job
Responsibilities
- Own policies, processes, and quality standards for insurance carriers, plans, and taxonomies across the marketplace.
- Define rules for adding, modifying, retaining, and removing insurance carriers and plans.
- Monitor U.S. health insurance market trends, including carrier launches, plan introductions, mergers, and regulatory changes.
- Partner with Product, Engineering, Operations, and Data & Analytics teams to translate insurance policies into product requirements, data models, business rules, and acceptance criteria.
- Advise product and engineering leaders on recommendations, tradeoffs, taxonomy architecture, validation logic, tooling, and system controls.
- Define and monitor insurance database health metrics and lead reviews of trends and improvement priorities.
- Lead incident reviews and escalations involving inaccurate insurance availability or provider matching.
- Identify systemic data-quality issues and lead process-improvement initiatives to increase efficiency and accuracy.
- Review and validate operational outputs for insurance-plan additions and complex taxonomy decisions.
- Serve as the final escalation point for insurance policy interpretation and quality questions.
Requirements
- Bachelor's degree with a strong academic record.
- 5+ years of experience in the U.S. healthcare industry, with expertise in insurance payor management, payor analytics, database management, or related payor- or plan-level functions.
- Strong understanding of U.S. commercial insurance plans, carriers, and provider networks.
- Strong analytical skills and experience using metrics and data to drive strategic and operational improvements.
- Experience partnering cross-functionally with Product, Operations, Analytics, and Engineering teams.
- Excellent problem-solving, verbal communication, and written English skills.
- Strong attention to detail and ability to influence cross-functional stakeholders.
- Experience with SQL, Excel, Google Sheets, Looker, or comparable analytical tools.
- Proven use of AI-driven tools and workflow automation.
Benefits
- Competitive compensation package, including medical insurance.
- Catered meals and workplace perks.
- Daycare/creche facility.
- Corporate wellness programs.
- Cellphone and Wi-Fi reimbursement.
- Competitive parental leave.
- Sabbatical leave after five years.
- Annual sponsored health check-ups.
Skills
SQL, Excel, Google Sheets, Looker, Workflow Automation, Artificial Intelligence, Insurance Taxonomy, Payor Management, Payor Analytics, Database Management, Provider Networks, Data Quality, Business Rules, Data Models, Metrics
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