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

Molina Healthcare•United States,

6d•$63,133 - $129,589•Remote

About The Position

Molina Healthcare of Nebraska is hiring a Senior Analyst, Provider and Claim Data & Analytics. The position is remote for candidates within the United States. The analyst provides senior-level support for data analysis and reporting across healthcare and business domains, including claims, utilization, finance, pharmacy, lab, cost, and business performance. The role organizes data from multiple sources and develops reports, dashboards, analyses, forecasts, models, and recommendations to support strategic and operational decisions and cost containment. The analyst translates business needs into analytical and reporting requirements, works with stakeholders and cross-functional teams, and develops scalable data processes and solutions. The role supports data quality and integrity, network adequacy and provider data cleanup, regulatory and contractual reporting, projects, audits, and process improvements. It also documents reporting methods and workflows, presents findings to leadership and other stakeholders, and trains and supports data analysis team members.

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 the ability to interpret complex datasets, identify patterns, and translate findings into actionable insights.
Technical proficiency with SQL, Excel, and reporting or analytics tools, and the 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.
Attention to detail and accuracy in data validation, report development, and documentation.
Ability to work cross-functionally across 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.
Ability to perform root cause analysis.
Self-starter who can adapt and pivot as needed while maintaining strong attention to detail.
Experience with Medicaid and managed care, claims, and coding is sought in highly qualified candidates; coder certification is not required.

Nice To Haves

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 with BI 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.
Coder certification.

Responsibilities

Organize data from multiple sources and produce reports, dashboards, and analyses related to utilization, cost containment, and business performance.
Design, develop, and maintain reports, dashboards, and data solutions using SQL, Microsoft Excel, SSRS, and other applicable tools.
Analyze complex datasets to identify trends, patterns, risks, and opportunities.
Translate business needs into reporting and analytical requirements and partner with stakeholders to deliver actionable insights.
Analyze healthcare data related to claims, pharmacy, lab, utilization, cost, and other areas.
Develop and maintain processes for data extraction, transformation, validation, and integration.
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 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 analyzing provider claims and leading provider data cleanup efforts.