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

Molina Healthcare•Long Beach, CA

6d•Remote

About The Position

Molina Healthcare of Nebraska is hiring a Senior Analyst, Provider and Claim Data & Analytics. The position is remote within the United States. The analyst provides senior-level support for data analysis and reporting, organizing information from multiple sources to produce reports, dashboards, and analyses related to utilization, cost containment, and business performance. The role develops data-related insights for strategic and operational decision-making and designs and delivers reporting, analytics, and data solutions across healthcare and business domains, including claims, utilization, and finance. The analyst works with stakeholders to define requirements and develop scalable reporting and data processes, applying analytical techniques to identify trends, forecast outcomes, and support business performance. The role also supports projects, regulatory requests, and initiatives to improve data quality, reporting workflows, and process efficiency. This includes analyzing complex datasets; developing and maintaining reports, dashboards, and data solutions; validating data; documenting methodologies and workflows; and presenting findings and recommendations to stakeholders and leadership. Highly qualified candidates will bring Medicaid and managed care claims and coding experience, root-cause analysis skills, strong SQL and Excel skills, and the ability to support network adequacy and provider data integrity by investigating provider claims and leading provider data-cleanup efforts. A coder certification is a plus but is not required. The successful candidate is a self-starter with strong attention to detail who can adapt and help where needed.

Requirements

At least 4 years of experience in data analysis, reporting, or healthcare analytics, or an equivalent combination of relevant education and experience.
Analytical problem-solving skills, including interpreting complex datasets, identifying patterns, and translating findings into actionable insights.
Technical proficiency with SQL, Excel, and reporting or analytics tools, and ability to learn new technologies quickly.
Experience with healthcare analytics, such as claims, utilization, cost containment, or medical economics.
Experience working with complex datasets and providing data analysis and insights.
Experience with healthcare utilization metrics, medical cost analysis, and performance indicators.
Strong attention to detail and accuracy in data validation, report development, and documentation.
Ability to work cross-functionally in a highly matrixed organization.
Effective verbal, written, and interpersonal communication skills, including the ability to clarify requirements and present data-related findings and solutions.
Proficiency with Microsoft Office and applicable software programs.
Strong SQL skills, including writing queries or formulas, and strong Excel skills.
Medicaid and managed care claims and coding experience.
Ability to perform root-cause analysis.
Ability to investigate provider claims and support provider data integrity and network adequacy.

Nice To Haves

Coder certification; it is a plus but not required.
Experience with SSRS, Crystal Reports, MedInsight, Power BI, relational databases, or similar tools.
Experience with CRM systems such as Salesforce.
Experience with ETL tools such as SSIS and data warehousing concepts.
Familiarity with cloud data platforms such as Azure data lakes and business intelligence tools.
Experience supporting regulatory reporting and healthcare payer systems such as QNXT or similar platforms.
Familiarity with predictive modeling concepts and trend forecasting.
Project management experience.
Microsoft certification or similar technical credentials.

Responsibilities

Organize data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost containment, and business performance.
Generate insights that support strategic and operational decision-making and cost containment.
Design, develop, and maintain reporting, analytics, and data solutions across healthcare and business domains, including claims, utilization, finance, and other areas.
Partner with stakeholders to define reporting requirements and develop scalable reporting and data processes.
Analyze complex datasets from multiple sources to identify trends, patterns, risks, and opportunities.
Use SQL, Excel, and reporting tools such as SSRS to support utilization analysis, cost containment, and operational performance.
Translate business needs into reporting and analytical requirements and deliver actionable insights.
Analyze healthcare data related to claims, pharmacy, laboratory, utilization, cost, and other areas.
Develop and maintain data extraction, transformation, validation, and integration processes.
Ensure data accuracy, integrity, and consistency through quality assurance and validation.
Create forecasts, models, and recommendations based on statistical analysis and business context.
Organize, document, and maintain datasets and reporting workflows across multiple business areas.
Consolidate research and analysis into clear summaries and recommendations for business stakeholders.
Support regulatory, contractual, enterprise, and state-mandated reporting requirements.
Identify and implement enhancements or fixes to existing reports and reporting processes.
Collaborate with cross-functional teams to define reporting requirements and maintain project and report timelines.
Document methodologies, reporting processes, and business requirements.
Identify and drive process improvements, standardization, and automation opportunities.
Lead or support projects, including timeline management, requirements gathering, and deliverable execution.
Present findings and recommendations to leadership and cross-functional teams.
Support regulatory, audit, and ad hoc data requests.
Provide training and support to new and existing data analysis team members.
Support network adequacy and provider data integrity by investigating provider claims and leading provider data-cleanup efforts.