Senior Analyst, Data & Analytics - No Surprises Act/Provider Reimbursements/SQL - Remote

About Molina Healthcare Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.

Molina Healthcare

Managed CarePrimary Care ClinicsMedicaidand Medicare

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careers.molinahealthcare.com

10,001+ employees

Hospitals and Health Care

Long Beach, California

Public Company

336k LinkedIn followers

Raised $2.4B

• The Senior Analyst, OON Dispute Analytics and Reporting, 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 Director, 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.
• 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
• Director, 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
• negotiations escalated to IDR, provider acceptance rate, IDR award versus
• QPA, IDR win rate, win rate by arbitrator, etc. Supports target-setting and
• performance management of dispute-related KPIs; establishes reporting views
• by market, state, provider, specialty, and arbitrator.
• Develops financial views that quantifies dispute exposure, settlement impact,
• arbitration outcomes and avoided cost; translates financial reporting outputs
• into actionable insights for negotiation strategy and health plan playbooks
• Develops visual dashboards that summarize OON dispute performance, financial
• impact, and strategic opportunities; creates executive-ready reporting
• materials for leadership reviews and governance forums; develops drill-down
• capability from enterprise-level performance to market, provider, specialty
• and case-level detail
• Presents findings and recommendations to leadership and cross-functional
• teams.

Required

• At least 4 years of experience in data analysis, reporting, or analytics, or
• equivalent combination of relevant education and experience.
• Strong experience with Structured Query Language (SQL), relational databases,
• and Microsoft Excel.
• Experience with reporting and visualization tools (e.g., SQL Server Reporting
• Services (SSRS) or similar).
• Experience working with complex datasets, including claims, provider,
• reimbursement, and financial data
• Demonstrated ability to manage multiple priorities and deliver on deadlines
• Advanced data analysis and critical thinking, with experience developing
• dashboards, scorecards, recurring reports, and executive-facing analytics
• Data quality & governance
• Stakeholder communication & influence, with ability to translate detailed
• data into clear business insights and recommendations
• Proficiency with data visualization and analytics tools, such as Tableau,
• Power BI, or other similar platforms

Preferred

• Experience with No Surprises Act IDR, state-based provider dispute processes,
• OON claims, or provider payment disputes
• Knowledge of QPA methodology, provider reimbursement, Medicare-based pricing,
• commercial benchmarks, or payer claims adjudication
• Experience combining internal data with external market data sources
• Advanced SQL, Python R, or Alteryx skills
• Experience with financial reporting, medical cost reporting, or healthcare
• P&L analysis
• Experience supporting provider contracting, network strategy, medical
• economics, or payment integrity teams
• To all current Molina employees: If you are interested in applying for this
• position, please apply through the Internal Job Board.
• Molina Healthcare offers a competitive benefits and compensation package. Molina

• Competitive benefits package
• Compensation package