Sr Manager, Payor Performance Analytics

UnitedHealth Group•Pearland, TX

4h•$91,700 - $163,700

About The Position

The Payor Performance Data Analytics Senior Manager serves as an analytical leader responsible for driving the financial, analytical, and operational components of Kelsey Seybold’s payer contracting strategy. This role oversees complex reimbursement modeling and partners cross functionally to ensure successful contract negotiations and implementation of new agreements. The Payor Performance Data Analytics Senior Manager plays a critical role in shaping the organization’s capitation and value based care portfolio, identifying opportunities for growth, and ensuring financial sustainability across all contract types. 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
5+ years Health Care or Health Plan analytical 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, and proficient in MS office products, and Power BI
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 knowledge with a strong understanding of Medicare Advantage Reimbursement and risk adjustment, capitation and value-based models.
Understanding of: Provider reimbursement methodologies (e.g., %25 of Medicare, DRG, case rates)

Nice To Haves

EPIC
Hands-on experience conducting cost and utilization analyses to identify actionable performance improvement opportunities within payer or value-based arrangements
Experience working with SQL servers and diverse data management systems across different platforms
Experience using a range of reporting and analytics tools beyond standard Microsoft Office, with the ability to adapt to different environments
Experience leading health plan performance reporting, including cost, utilization, and benchmarking across Commercial, Medicare Advantage, and Marketplace products
Experience managing financial reporting for value-based care programs, including shared savings and shared risk models, with responsibility for reconciling claims, capitation, and medical expense data
Experience working with Risk Adjustment Factor (RAF) analytics and collaborating with health plans to improve Medicare Advantage performance
Experience presenting financial performance results and strategic insights in payer-facing settings, including Joint Operating Committee (JOC) meetings
Working knowledge of payer financial models, reimbursement structures, and large healthcare datasets in practical applications
Familiarity with healthcare data analysis without deep specialization in regulatory frameworks or advanced analytics tools

Responsibilities

Serve as an analytical leader responsible for driving the financial, analytical, and operational components of Kelsey Seybold’s payer contracting strategy.
Oversee complex reimbursement modeling.
Partner cross functionally to ensure successful contract negotiations and implementation of new agreements.
Shape the organization’s capitation and value based care portfolio.
Identify opportunities for growth.
Ensure financial sustainability across all contract types.