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Sr Medicare Advantage Data Ops Specialist
Harvard Pilgrim Health Care (Wellesley,USA)
Computer and Information Technology
Career Level:
Management C-Level
Job Type:
Position Open


Job description

Are you interested in becoming part of a dynamic team that is looking to innovate and improve?


Would you like to work for a company that has been rated by the BBJ (15 yrs) as one of the best places to work?


Do you want to be part of a company that is committed to giving back to the community?


Harvard Pilgrim Health Care is currently seeking highly motivated individuals to join our organization as Sr. Medicare Advantage Data Ops Spec. The Sr. Medicare Advantage Data Ops Spec is responsible for being the business lead, technical subject matter expert, analyst and data quality steward responsible for maintaining and communicating guidelines to ensure a continual state of organizational readiness to produce timely and compliant data submissions for CMS and other regulatory and operational audits of transactional data.


What You Will Be Doing


  • Design, develop and routinely produce executive level operational dashboards and provide timely response to requests for more information. Collaborate with leadership to understand business and reporting needs and make recommendations on various elements including data sources and presentation options.
  • Proactively monitor CMS regulatory requirements and industry developments related to operational audits and universe submissions. Maintain required documentation in a format accessible and understandable to others in the organization.
  • Manage and facilitate work sessions with applicable business leads to perform a detailed review of revisions to specifications to confirm and document understanding. Research and evaluate options when protocols are not clearly defined or consistently understood and make recommendations with appropriate risk assessment and rationale.
  • Lead data collection effort when audit notices are received. Promptly confirm technical specifications and timelines for submission with applicable business partners. Quality check data submissions, facilitate timely resolution of identified issues and aggregate data from internal and external data sources into relevant consolidated tables.
  • Collaborate with the IT team to utilize and further develop automation tools and best practices for data extraction, file validation, other quality checks and archiving.
  • Perform out-of-the-box thinking, collaborate with others, and make a difference every day!
  • Other duties and projects as assigned.


What You Need


  • Bachelor's Degree in IT, Data Management, Business or related field. Demonstrated experience (7 years) in data analysis and management reporting in a professional capacity.
  • At least 5 years health insurance experience with a strong preference for knowledge of Medicare Advantage regulatory references, industry terms and audit practices.
  • Advanced proficiency with Microsoft Excel and Powerpoint as well as solid fundamental understanding of database structures. Working knowledge of Microsoft Word, Visio and Access. SAS and Sequel capabilities desired but not essential. Sufficient knowledge of statistics to independently develop appropriate queries, analyze results and prepare reports that lead to appropriate conclusions.
  • Ability to manage the details with accuracy along with the ability to understand how work products influence or impact the big picture.
  • Resilient, collaborative, flexible, innovative.


What Makes Us Stand Out


  • Work-Life-Flexibility
  • Paid volunteer time off (up to 3 days annually)
  • Open Time Off
  • Annual Mini-Grant of $500 donated to a non-profit organization of the employee's choice
  • Educational Reimbursement


Working Environment


General office environment with occasional travel to other HPHC locations.

Seniority Level



  • Insurance
  • Financial Services
  • Hospital & Health Care

Employment Type


Job Functions

  • Management
  • Manufacturing

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