Senior Analyst, Data & Analytics - No Surprises Act/Provider Reimbursements/SQL

Job Summary

The Senior Analyst, OON Dispute Analytics and Reporting, supports the out-of-network (OON) provider liability operating model by developing the analytics, reporting, and market intelligence needed to inform the negotiation strategy, arbitration positioning, QPA payment accuracy, and overall IDR performance. The role reports to the Director, Provider Dispute Strategy, and serves as the primary analytics partner for pre-IDR negotiation, federal NSA IDR, state-based dispute processes, and provider-level OON liability management. The Senior Analyst is responsible for integrating data from multiple internal and external sources, building reporting dashboards, producing actionable insights, and translating financial and operational data into recommendations that support improved dispute outcomes. This role requires strong data management, healthcare finance, reimbursement, and reporting capabilities, as well as the ability to connect claim-level detail, dispute outcomes, provider behavior, QPA performance, market benchmarks, and financial reporting trends. The role partners with stakeholders to define requirements, develop scalable reporting and data processes, and apply advanced analytical techniques to identify trends, forecast outcomes, and drive business performance.

Job Duties

• Analyzes complex datasets from multiple sources to identify trends, patterns, risks, and opportunities. Tracks performance across pre-IDR negotiation, open negotiation, arbitration, settlement, and post-award outcomes.
• Designs, develop, and maintain reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS). Produces standard and ad hoc reporting for Director, Network Strategy, Finance, Operations and health plan stakeholders.
• Translates business needs into reporting and analytical requirements; partner with stakeholders to deliver actionable insights.
• Combines data from multiple internal and external sources, including claims, QPA data, IDR case tracking, negotiation records, provider data, financial reporting, market benchmarks, and third-part data sources.
• Performs healthcare data analysis, including claims, utilization, and cost data. Leverages external data sources as well to inform trends.
• Develops and maintains data processes for extraction, transformation, validation, and integration.
• Ensures data accuracy, integrity, and consistency through quality assurance and validation processes. Reconciles data across systems and identifies gaps, inconsistencies, and quality issues.
• Partners with IT, Finance, Medical Economics, Actuary and Operations / Shared Services and external vendors to improve data availability and reporting automation, specifically collaborating with the provider dispute intake team
• Produces and monitors key performance metrics, including: Percent of cases settled pre-IDR, averaged negotiated rate versus initial offer, percent of negotiations escalated to IDR, provider acceptance rate, IDR award versus QPA, IDR win rate, win rate by arbitrator, etc. Supports target-setting and performance management of dispute-related KPIs; establishes reporting views by market, state, provider, specialty, and arbitrator.
• Develops financial views that quantifies dispute exposure, settlement impact, arbitration outcomes and avoided cost; translates financial reporting outputs into actionable insights for negotiation strategy and health plan playbooks
• Develops visual dashboards that summarize OON dispute performance, financial impact, and strategic opportunities; creates executive-ready reporting materials for leadership reviews and governance forums; develops drill-down capability from enterprise-level performance to market, provider, specialty and case-level detail
• Presents findings and recommendations to leadership and cross-functional teams.

Job Qualifications

• At least 4 years of experience in data analysis, reporting, or analytics, or equivalent combination of relevant education and experience.
• Strong experience with Structured Query Language (SQL), relational databases, and Microsoft Excel.
• Experience with reporting and visualization tools (e.g., SQL Server Reporting Services (SSRS) or similar).
• Experience working with complex datasets, including claims, provider, reimbursement, and financial data
• Demonstrated ability to manage multiple priorities and deliver on deadlines
• Advanced data analysis and critical thinking, with experience developing dashboards, scorecards, recurring reports, and executive-facing analytics
• Data quality & governance
• Stakeholder communication & influence, with ability to translate detailed data into clear business insights and recommendations
• Proficiency with data visualization and analytics tools, such as Tableau, Power BI, or other similar platforms

PREFERRED QUALIFICATIONS:

• 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

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Originally posted on Himalayas