Senior Analyst, Data & Analytics at Molina Healthcare
Remote — full-time
The Senior Analyst, Data & Analystcs, supports the out-of-network (OON) provider liability operating model by developing the analytics, reporting, and market intelligence needed to inform the negotiation strategy, arbitration positioning, QPA payment accuracy, and overall IDR performance. The role reports to the Manager, Provider Dispute Strategy, and serves as the primary analytics partner for pre-IDR negotiation, federal NSA IDR, state-based dispute processes, and provider-level OON liability management. The Senior Analyst is responsible for integrating data from multiple internal and external sources, building reporting dashboards, producing actionable insights, and translating financial and operational data into recommendations that support improved dispute outcomes. This role requires strong data management, healthcare finance, reimbursement, and reporting capabilities, as well as the ability to connect claim-level detail, dispute outcomes, provider behavior, QPA performance, market benchmarks, and financial reporting trends. The role partners with stakeholders to define requirements, develop scalable reporting and data processes, and apply advanced analytical techniques to identify trends, forecast outcomes, and drive business performance. Job Duties • Analyzes complex datasets from multiple sources to identify trends, patterns, risks, and opportunities. Tracks performance across pre-IDR negotiation, open negotiation, arbitration, settlement, and post-award outcomes. • Designs, develop, and maintain reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS). Produces standard and ad hoc reporting for Manager, Network Strategy, Finance, Operations and health plan stakeholders. • Translates business needs into reporting and analytical requirements; partner with stakeholders to deliver actionable insights. Combines data from multiple internal and external sources, including claims, QPA data, IDR case tracking, negotiation records, provider data, financial reporting, market benchmarks, and third-part data sources. • Performs healthcare data analysis, including claims, utilization, and cost data. Leverages external data sources as well to inform trends. • Develops and maintains data processes for extraction, transformation, validation, and integration. • Ensures data accuracy, integrity, and consistency through quality assurance and validation processes. Reconciles data across systems and identifies gaps, inconsistencies, and quality issues. • Partners with IT, Finance, Medical Economics, Actuary and Operations / Shared Services and external vendors to improve data availability and reporting automation, specifically collaborating with the provider dispute intake team • Produces and monitors key performance metrics, including: Percent of cases settled pre-IDR, averaged negotiated rate versus initial offer, percent of negotiation