Senior Healthcare Data Analyst, Provider Network - Kelsey Seybold, Pearland, TX
About The Position
The Sr. Data Analyst supports financial and operational performance across Commercial, Medicare Advantage and ACA Marketplace products within the Texas market. This role focuses on analyzing medical costs, utilization, and provider network performance to drive strategic decision-making, ensure regulatory compliance (TDI and CMS), and optimize financial outcomes. The analyst partners closely with payor strategy, finance, actuarial, and clinical operations to evaluate provider performance, support contract negotiations, and ensure network adequacy while balancing cost, access, and quality. This role is expected to leverage advanced analytics and emerging AI-enabled tools to improve data efficiency, enhance predictive insights, and support informed financial and network strategy decisions while ensuring data governance and regulatory compliance. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- Bachelor’s degree or equivalent work experience
- EPIC
- 10+ years of Health Care or Health Plan experience
- Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services.
- Knowledge of CMS rules and regulations, Managed Care payment methodologies, proficient in MS office products, Power BI, Tableau and process improvement methodology
- Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures
- Experience applying AI-enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL-based environments) to support healthcare financial analysis and decision-making
- Healthcare & Texas Market Knowledge with a solid understanding of Medicare Advantage Reimbursement and risk adjustment, ACA Marketplace dynamics, capitation and value-based models.
- Familiarity with: Texas Department of Insurance (TDI) requirements, including network adequacy, CMS regulations and compliance requirements.
- Understanding of: Provider reimbursement methodologies (e.g., %25 of Medicare, DRG, case rates)
- Proven excellent written and verbal communication skills, solid analytical and problem-solving abilities and high attention to detail
Responsibilities
- Analyze medical costs, utilization, and provider network performance.
- Drive strategic decision-making.
- Ensure regulatory compliance (TDI and CMS).
- Optimize financial outcomes.
- Evaluate provider performance.
- Support contract negotiations.
- Ensure network adequacy while balancing cost, access, and quality.
- Leverage advanced analytics and emerging AI-enabled tools to improve data efficiency, enhance predictive insights, and support informed financial and network strategy decisions.
- Ensure data governance and regulatory compliance.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
