Senior Analyst, Provider and Claim Data & Analytics (Remote) at Molina Healthcare

United States

$63.133k - $129.589k

<p>Molina Healthcare of Nebraska is hiring for a Senior Analyst, Provider and Claim Data &amp; Analytics. This role is remote for those within the United States.&nbsp;</p> <p><strong>Highly Qualified Candidates Will Have the Following Experience-</strong></p> <ul> <li>Medicaid and managed care</li> <li>Claims and coding experience. A coder certification is a plus but not required</li> <li>Ability to support network adequacy and provider data integrity by digging into provider claims and lead provider data clean-up efforts.</li> <li>Root cause analysis</li> <li>Strong SQL skills, including writing their own formulas or queries along with strong Excel skills</li> <li>Be a self-starter who can jump in where needed, pivot when required, all while having strong attention to detail</li> </ul> <p><strong>Essential Job Duties</strong></p> <ul> <li>Provides senior level analyst support for data analysis and reporting activities. &nbsp;Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance. &nbsp;Generates data-related insights that support strategic and operational decision-making and cost-containment. &nbsp;Designs and delivers reporting, analytics, and data solutions across business and healthcare domains, including claims, utilization, finance, and other business areas. &nbsp;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. &nbsp;Supports projects, regulatory requests, and initiatives that improve data quality, reporting workflows, and process efficiencies.</li> <li>Analyzes complex datasets from multiple sources to identify trends, patterns, risks, and opportunities.&nbsp;</li> <li>Designs, develops, and maintains reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS), that support utilization analysis, cost-containment, and operational performance.</li> <li>Translates business needs into reporting and analytical requirements; partners with stakeholders to deliver actionable insights.&nbsp;</li> <li>Facilitates healthcare data analysis, including data related to claims, pharmacy, lab, utilization, cost, and other areas.&nbsp;</li> <li>Develops and maintains data processes for extraction, transformation, validation, and integration.&nbsp;</li> <li>Ensures data accuracy, integrity, and consistency through quality assurance and validation processes.&nbsp;</li> <li>Creates forecasts, models, and recommendations based on statistical analysis and business context.&nbsp;</li> <li>Organizes, documents, and maintains datasets and reporting workflows across multiple business areas.</li> <li>Consolidates research and analysis into clear summaries and recommendations for business stakeholders.</li> <li>Supports regulatory, contractual, and enterprise reporting requirements, including state mandated submissions.</li> <li>Identifies and implements enhancements or fixes to existing reports and reporting processes.</li> <li>Collaborates with cross-functional teams to define reporting requirements and maintain project/report timelines.</li> <li>Documents methodologies, reporting processes, and business requirements.&nbsp;</li> <li>Identifies and drives process improvements, standardization, and automation opportunities.&nbsp;</li> <li>Leads or supports projects, including timeline management, requirements gathering, and deliverable execution.</li> <li>Presents findings and recommendations to leadership and cross-functional teams.</li> <li>Supports regulatory, audit, and ad hoc data requests as needed.</li> <li>Provides training and support to new and existing data analysis team members.</li> </ul> <p><strong>Required Qualifications</strong></p> <ul> <li>At least 4 years of experience in data analysis, reporting, or healthcare analytics, or equivalent combination of relevant education and experience.&nbsp;</li> <li>Analytical problem-solving skills, including ability to interpret complex datasets, identify patterns, and translate findings into actionable insights.</li> <li>Technical proficiency with SQL, Excel, and reporting/analytics tools, and ability to learn new technologies quickly.</li> <li>Experience with healthcare analytics (e.g., claims, utilization, cost containment, medical economics).</li> <li>Experience working with complex datasets/provision of data analysis and insights.</li> <li>Experience with healthcare utilization metrics, medical cost analysis, and performance indicators.</li> <li>Attention to detail, accuracy in data validation, report development, and documentation.</li> <li>Ability to work cross-functionally across a highly matrixed organization. &nbsp;</li> <li>Effective verbal, written, and interpersonal communication skills, and ability to collaborate with cross-functional teams to clarify requirements and present data-related findings and solutions.</li> <li>Microsoft Office suite and applicable software programs proficiency.</li> </ul> <p><strong>Preferred Qualifications</strong></p> <ul> <li>Experience with SQL Server Reporting Services (SSRS), Crystal Reports, MedInsight, Power BI, relational databases or similar tools.</li> <li>Experience with customer relationship management (CRM) systems (e.g., Salesforce).&nbsp;</li> <li>Experience with Extract, Transform, Load (ETL) tools such as SQL Server Integration Services (SSIS) and data warehousing concepts.&nbsp;</li> <li>Familiarity with cloud data platforms (e.g., Azure data lakes) and business intelligence (BI) tools.</li> <li>Experience supporting regulatory reporting and healthcare payer systems (e.g., QNXT or similar platforms).</li> <li>Familiarity with predictive modeling concepts and trend forecasting.</li> <li>Project management experience.</li> <li>Microsoft certification or similar technical credentials.<br> &nbsp;</li> </ul> <p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br> Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p> <p>&nbsp;</p>