Analyst II - Grievance & Appeals

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Analyst II - Grievance & Appeals position is fully competent to perform responsible and difficult analytical work in varied support areas designated by management. Projects may include statistical analyses, operations support, policy, procedure and budget development, or program implementation and administration, or other areas which may be for IEHP or specific to a department. Incumbents are expected to exercise independent judgment in selecting study approach and analytical techniques, and in making sound recommendations. The Analyst II - Grievance & Appeals will perform a wide range of functions related to healthcare data analysis and decision support; support Grievance & Appeal data collection and management, which includes analysis and reporting; will provide support for Grievance & Appeal daily operations, IEHP’s strategic initiatives and cross-functional collaboration.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Plan and organize complex studies relating to the activities or operations of the departments or functional areas to which assigned.
2. Determine analytical techniques and information-gathering processes and obtain required information and data for analysis and will prepare presentations on analysis findings.
3. Analyze alternatives and makes recommendations regarding organizational planning.
4. Partner in the development and implementation of department or division goals and objectives.
5. Collaborate with department Team Members to coordinate, compile and monitor assigned projects and reports to ensure reporting is accurate, complete and submitted timely.
6. Track and analyze regulation changes and prepare for audits (DHCS, DMHC, CMS, etc.), including but not limited to, coordination and preparation of documentation for all audits. 
7. Compile, analyze, and prepare daily intradepartmental reports, monthly interdepartmental reports, quarterly grievance reports, and annual budget reports.
8. Analyze report requests to determine users’ needs and objectives, identify the correct criteria to meet reporting request to ensure the delivered report is accurate, timely, and formatted appropriately.
9. Document all reporting projects and reports within a project consistently, following department protocols, ensure updates to department processes and standard reporting documentation is completed as updates occur.
10. Troubleshoot reporting issues as well as incorrect data results.  
11. Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit(s).
12. Provide Business support to database users and work as a liaison between database users and the IT department as needed.
13. Maintain knowledge of the various data sources utilized by the department for regulatory reporting, as well as a clear understanding of IEHP business operations to be able to appropriately apply criteria and methodology to meet requestors’ reporting needs.
14. Support and participate in LEAN initiatives; facilitate and manage operational projects using A3 thinking and LEAN concepts
15. Demonstrate commitment to Team Member Engagement by participating in projects/tasks/activities that promote Team Member excitement and enthusiasm for their role, increased work effort, and commitment to the organization.
16. Conduct a variety of special projects and studies related to the functions of the department or functional area to which assigned. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• Three (3) or more years of experience in report writing and analysis, including extensive use and understanding of MS Access, Excel, Visio, Word, and Power Point
• Bachelor’s degree in a health, business, or related field from an accredited institution required
  • Master’s degree from an accredited institution preferred

Key Qualifications

• Experience in the healthcare field and/or Grievance & Appeal Health Plan experience preferred
• Knowledge in report writing from data warehouse, application database or specific report writing tools. Must demonstrate an understanding in research and data analysis, drawing actionable insights from raw data, and synthesizing information to drive results. Knowledge of managed care principles and experience in related organization
• Communicate clearly and effectively both in speaking and in writing. Data analysis, word processing, spreadsheet, and some database capabilities. Excellent interpersonal/communication skills. Excellent data collection and systemization abilities
• Ability to handle multiple projects, data input, strong problem-solving capability. Exercise sound independent judgment within established guidelines. Establish and maintain effective working relationships with those contacted in the course of the work. High attention to detail and accuracy

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA)