SQL - Remote

Molina Healthcare•Long Beach, CA

10d•Remote

About The Position

The Senior Analyst, OON Dispute Analytics and Reporting supports the out-of-network provider liability operating model by developing analytics, reporting, and market intelligence to inform negotiation strategy, arbitration positioning, QPA payment accuracy, and overall IDR performance. Reporting to the Director, Provider Dispute Strategy, this position 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 that support improved dispute outcomes. It requires data management, healthcare finance, reimbursement, and reporting capabilities, including connecting claim-level detail, dispute outcomes, provider behavior, QPA performance, market benchmarks, and financial reporting trends. The Senior Analyst partners with stakeholders to define requirements, develop scalable reporting and data processes, and apply analytical techniques to identify trends, forecast outcomes, and drive 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 influencing 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.
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.

Responsibilities

Analyze complex datasets from multiple sources to identify trends, patterns, risks, and opportunities, and 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 strategy, finance, operations, and health plan stakeholders.
Translate business needs into reporting and analytical requirements and partner with stakeholders to deliver actionable insights.
Combine internal and external data sources, including claims, QPA data, IDR case tracking, negotiation records, provider data, financial reporting, market benchmarks, and third-party data.
Analyze healthcare claims, utilization, and cost data, using external sources to inform trends.
Develop and maintain processes for data extraction, transformation, validation, and integration.
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, and external vendors to improve data availability and reporting automation, including collaboration with the provider dispute intake team.
Produce and monitor dispute performance metrics, including pre-IDR settlement rates, average negotiated rates versus initial offers, escalation rates, provider acceptance rates, IDR awards versus QPA, IDR win rates, and win rates 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 outputs 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-level detail.
Prepare executive-ready reporting materials for leadership reviews and governance forums.
Present findings and recommendations to leadership and cross-functional teams.