Analyst, National Risk Adjustment Predictive Analytics (Remote)

Molina Healthcare; Northern (KY); Hybrid; USD 55,000 - 107,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Kentucky is seeking an analytics professional to support enterprise risk adjustment predictive analytics. You will design and develop systems to support proactive interventions and retrospective reviews.

The role emphasizes SQL, T-SQL, SSIS/SSRS, Power BI, and cloud platforms, with a focus on QA reporting for Medicaid, Marketplace, and MMP lines. Ideal candidates bring strong data modeling skills and the ability to translate insights into business actions.

Qualifications

• 2+ years of experience writing complex SQL queries and data design.
• Experience with healthcare quality metrics and HEDIS forecasting.
• Ability to handle large datasets and perform root-cause analysis.
• Strong communication to non-technical audiences.

Responsibilities

• Assists risk adjustment data analytics leaders in intervention analytics and tracking.
• Develops QA ad-hoc and automated reporting modules for Medicaid, Marketplace, and MMP.
• Assists in developing automated suspect and ranking engine for all lines of business.
• Facilitates analysis of managed care data including claims, pharmacy, lab and related financial data.
• Calculates and tracks risk scores for intervention outcomes across markets.
• Performs data analysis and root-cause analysis in an agile environment.
• Conducts root-cause analysis for business data issues.
• Analyzes data trends for anomalies and predicts future cost/utilization.
• Supports special projects for internal departments or regulatory requests.

Skills

SQL

Power BI

T-SQL

SSIS

SSRS

Data Modeling

Healthcare Analytics

Problem Solving

Tools

Azure

AWS

Hadoop

Databricks

Job description

Provides analyst support for Molina enterprise risk adjustment predictive analytics activities. Designs and develops suspect, targeting, and tracking system to support Molina’s prospective and retrospective interventions.

Essential Job Duties

• Assists risk adjustment data analytics leaders in prospective and retrospective intervention strategy analytics, and corresponding tracking of progress and impact of interventions.
• Develops quality assurance (QA) ad-hoc and automated reporting modules related to risk adjustment for Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Assists risk adjustment data analytics leaders in developing automated suspect and target/ranking engine for all lines of businesses.
• Facilitates analysis and reporting related to managed care data including claims, pharmacy, lab and related financial data (risk score/revenue/cost).
• Calculates and tracks risk scores for all intervention outcomes for all markets/lines of business.
• Works in an agile business environment; derives meaningful information out of complex/large organizational data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
• Assists with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

Required Qualifications

• At least 2 years of experience writing complex SQL queries, functions, procedures, and data design, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI, and predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.
• Analytical mindset, excellent attention to detail, and problem-solving skills.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong business acumen with the ability to connect data insights to strategic goals.
• Ability to communicate complex analytical results clearly to non-technical audiences.
• Proven ability to lead cross-functional projects and deliver value added results in a highly matrixed environment.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency.

Preferred Qualifications

• Familiarity with data science techniques and languages like Python and R programming.

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

Pay Range: $54,922 - $107,099 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.