Health Plan Provider Network Operations Specialist

Health Plan Provider Network Operations Specialist

The Opportunity:  

On our team, you’ll use your analytical skills and data science knowledge to create real-world impact. You’ll work closely with your clients to understand their questions and needs, and then dig into their data-rich environments to find the pieces of their information puzzle. You’ll develop algorithms and systems and use the right combination of tools and frameworks to turn sets of disparate data points into objective answers to help clients make informed decisions. Ultimately, you’ll provide a deep understanding of the data, what it all means, and how it can be used.  

Booz Allen is seeking an experienced health plan data analyst with direct experience in analyses to determine health plan provider network adequacy, provider directory compliance and other various analytic tasks regarding health plan operations. This individual should have a deep understanding of health plan operations. Additionally this individual should understand the data that underlie critical health plan processes, and the strengths and limitations of typical health plan data. Work with us as we use data science for good.  

Join us. The world can’t wait.  

You Have:   

• 4+ years of experience in a federal, state, or commercial health plan analytics role

• 4+ years of experience with common data analysis tools including SAS, Python, SQL, or R

• 3+ years of experience with health insurance claims data

• Experience with performing health care provider network adequacy analyses for health insurance companies

• Knowledge of common provider network adequacy evaluation methods including how to establish network adequacy standards and how to evaluate a provider network against established standards

• Knowledge of the structure of healthcare provider networks and statistical or analytical methods for evaluating network utilization

• Ability to clean and analyze raw claims and administrative data for trends over time

• Ability to perform Quality Assurance (QA) reviews of data and analyses

• Ability to obtain and maintain a Public Trust or Suitability/Fitness determination based on client requirements

• Bachelor’s degree in Business, Finance, Statistics, Economics, or Public Health

Nice If You Have:   

• Experience with using ArcGIS, Quest, or similar mapping software for provider network adequacy analyses

• Experience with the federal procurement process

• Experience leading teams of analysts

• Knowledge of industry standards and federal regulations and guidance related to the management of provider networks

• Knowledge of common data sources for health care provider data such as the Provider Enrollment, Chain, and Ownership System (PECOS), National Plan and Provider Enumeration System (NPPES) and National Provider Identifier (NPI) registry

• Knowledge of provider credentialing processes

• Knowledge of provider directories

• Ability to explain complex analytical methods and data to non-technical audiences in both written and verbal communications 

Vetting:

Applicants selected will be subject to a government investigation and may need to meet eligibility requirements of the U.S. government client.

Create Your Career: 

Grow With Us 

Your growth matters to us—that’s why we offer a variety of ways for you to develop your career. With professional and leadership development opportunities like upskilling programs, tuition reimbursement, mentoring, and firm-sponsored networking, you can chart a unique and fulfilling career path on your own terms.  

A Place Where You Belong 

Diverse perspectives cultivate collective ingenuity. Booz Allen’s culture of respect, equity, and opportunity means that, here, you are free to bring your whole self to work. With an array of business resource groups and other opportunities for connection, you’ll develop your community in no time. 

Support Your Well-Being 

Our comprehensive benefits package includes wellness programs with HSA contributions, paid holidays, paid parental leave, a generous 401(k) match, and more. With these benefits, plus the option for flexible schedules and remote and hybrid locations, we’ll support you as you pursue a balanced, fulfilling