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

Molina Healthcare•Long Beach, CA

About The Position

The Senior Analyst, OON Dispute Analytics and Reporting supports the out-of-network (OON) provider liability operating model by developing analytics, reporting, and market intelligence that inform negotiation strategy, arbitration positioning, QPA payment accuracy, and overall IDR performance. Reporting to the Director, Provider Dispute Strategy, this role is the primary analytics partner for pre-IDR negotiation, federal NSA IDR, state-based dispute processes, and provider-level OON liability management. The role integrates data from internal and external sources, builds reporting dashboards, produces actionable insights, and translates financial and operational data into recommendations to improve dispute outcomes. It connects claim-level detail, dispute outcomes, provider behavior, QPA performance, market benchmarks, and financial reporting trends. In partnership with stakeholders, the Senior Analyst defines requirements, develops scalable reporting and data processes, and applies analytical techniques to identify trends, forecast outcomes, and support business performance.

Requirements

At least 4 years of experience in data analysis, reporting, or analytics, or an equivalent combination of relevant education and experience.
Strong experience with SQL, relational databases, and Microsoft Excel.
Experience with reporting and visualization tools such as SSRS or similar.
Experience working with complex datasets, including claims, provider, reimbursement, and financial data.
Ability to manage multiple priorities and deliver on deadlines.
Advanced data analysis and critical-thinking skills, including experience developing dashboards, scorecards, recurring reports, and executive-facing analytics.
Knowledge or experience in data quality and governance.
Stakeholder communication and influence skills, including the ability to translate detailed data into clear business insights and recommendations.
Proficiency with data visualization and analytics tools such as Tableau, Power BI, or similar platforms.

Nice To Haves

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.
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.

Responsibilities

Analyze complex datasets from multiple sources to identify trends, patterns, risks, and opportunities.
Track performance across pre-IDR negotiation, open negotiation, arbitration, settlement, and post-award outcomes.
Design, develop, and maintain reports, dashboards, and data solutions using SQL, Microsoft Excel, and SSRS.
Produce standard and ad hoc reporting for Director, Network Strategy, Finance, Operations, and health plan stakeholders.
Translate business needs into reporting and analytical requirements and partner with stakeholders to deliver actionable insights.
Combine claims, QPA, IDR case tracking, negotiation, provider, financial reporting, market benchmark, and third-party data.
Analyze healthcare claims, utilization, and cost data, using external data sources to inform trends.
Develop and maintain data extraction, transformation, validation, and integration processes.
Ensure data accuracy, integrity, and consistency through quality assurance and validation; reconcile data across systems and identify gaps, inconsistencies, and quality issues.
Partner with IT, Finance, Medical Economics, Actuary, Operations/Shared Services, external vendors, and the provider dispute intake team to improve data availability and reporting automation.
Produce and monitor dispute performance metrics, including pre-IDR settlement rates, negotiated rates versus initial offers, escalation to IDR, provider acceptance, IDR awards versus QPA, and win rates overall and by arbitrator.
Support target-setting and performance management for dispute-related KPIs, with reporting views by market, state, provider, specialty, and arbitrator.
Develop financial views quantifying dispute exposure, settlement impact, arbitration outcomes, and avoided cost; translate financial reporting into insights for negotiation strategy and health plan playbooks.
Develop visual dashboards summarizing OON dispute performance, financial impact, and strategic opportunities, with drill-down from enterprise performance to market, provider, specialty, and case detail.
Create executive-ready reporting materials for leadership reviews and governance forums.
Present findings and recommendations to leadership and cross-functional teams.