Sr Data Analyst

About the role

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary Under the supervision of a Manager for Reporting and Analytics, Government Programs, the Senior Data Analyst leads critical data submission activities for the Risk Adjustment Department (RAD). This role is accountable for the completeness, accuracy, and timeliness of Point32Health's All‑Payer Claims Database (APCD) submissions across applicable markets, as well as supporting the encounter data submissions to Rhode Island EOHHS. The analyst oversees internal data reconciliations, manages data exchanges with external partners, and supports regulatory reporting requirements. Serving as the primary point of contact for APCD-related initiatives and supporting RI‑EOHHS encounter submissions, the role collaborates with internal teams, external stakeholders, and state agencies to ensure compliance and operational excellence. The ideal candidate demonstrates strong analytical and critical‑thinking skills, with the ability to independently analyze large and complex datasets, assess data quality, identify trends and root causes, and translate findings into clear insights for leadership. Advanced SQL proficiency is required, and healthcare data knowledge is strongly preferred. Job Description DUTIES/RESPONSIBILITIES - what you will be doing: Data Management and Production: Independently manage and execute monthly APCD data submissions to state agencies for Tufts Health Plan and Harvard Pilgrim Health Care commercial and government products. Support RI EOHHS encounter data submissions, including error analysis, reconciliation, remediation, and end‑to‑end submission support. Ensure compliance with regulatory requirements, business rules, data standards, and technical specifications; document requirements and data logic as needed. Monitor and analyze encounter and APCD response files to identify rejections, discrepancies, and data quality issues; perform trend analysis and root‑cause investigations and drive timely resolution. Lead prioritized data remediation efforts for encounter and APCD defects in collaboration with business and technical partners. Develop, enhance, and automate reconciliation and reporting processes using SQL, SAS, Alteryx, and/or other analytical tools. Partner with IT and data engineering teams on enhancements and production issue resolution, including requirements clarification, issue investigation, UAT, and post‑implementation validation. Support encounter and APCD data readiness for risk adjustment, financial reconciliation, actuarial reporting, and regulatory audits. Serve as a subject‑matter expert for encounter and APCD data submission logic, providing guidance and recommendations to cross‑functional teams. Change Management and Process Improvement: Lead change management efforts related to state‑issued specifications and internal enhancements impacting encounter and APCD data submissions. Perform end‑to‑end issue analysis, including root‑cause identification, documentation of business requirements, implementation of data or process changes, user acceptance testing (UAT), and post‑implementation monitoring. Identify inefficiencies and improvement opportunities in monthly data submission, reconciliation, and tracking processes, and drive continuous improvement initiatives. Monitor the effectiveness of implemented changes, make necessary adjustments, and ensure sustained regulatory compliance and operational stability. Develop and maintain submission dashboards and reconciliation reports using Tableau, Excel, and other reporting tools to track acceptance rates, trends, and performance metrics. Collaboration and Stakeholder Management : Collaborate closely within the Risk Adjustment department and with cross‑functional partners including Claims, Member Operations, Information Technology, and Provider Information to ensure data submission processes and enhancements are effectively implemented and maintained. Partner with IT to support timely resolution of production issues, ensuring alignment between