Payer Analytics Consultant (Defined Term)

the Alliance; California; Remote; USD 125,000 - 140,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

Ample Paid Time Off

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

Onsite EV Charging Stations

Job summary

The Alliance is seeking a Payer Analytics Consultant for a defined term role. This remote position focuses on designing and validating managed care payer models while conducting financial analyses to support reimbursement outcomes.

The ideal candidate will have a Bachelor's degree in a relevant field and at least three years of experience in financial healthcare analysis. Strong communication and analytical skills are essential for collaborating across departments to achieve payer reimbursement objectives.

Benefits include comprehensive health plans, paid time off, and retirement options.

Qualifications

• Minimum of three years of experience performing financial healthcare reimbursement analysis.
• Experience with Windows-based PC systems and Microsoft Office applications.

Responsibilities

• Design and validate managed care payer models.
• Conduct financial analysis to support reimbursement outcomes.
• Coordinate with stakeholders to achieve reimbursement objectives.

Skills

Payer financial modeling

Data interpretation

Trend analysis

Scenario modeling

Collaborative problem-solving

Effective communication

Analytical skills

Critical thinking

Technical resource guidance

Education

Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or related field

Tools

Excel (including pivot tables)

SQL

Tableau

Job description

Overview

Payer Analytics Consultant (Defined Term) – Remote

Location: Remote, California; Remote in Pacific, Mountain and Central Time Zones. This defined term position is designated for a finite duration and may end on or before December 31, 2026. This role is fully benefited.

What you'll be responsible for

• Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
• Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
• Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives

About the team

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs.

The ideal candidate

• Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development.
• Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy.
• Collaborative and solutions-focused, working effectively across departments — including finance, provider network management, operations, and clinical teams — to align analytics with business goals.
• A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences.
• Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment.
• Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies.

What you'll need to be successful

• Knowledge of:
• Windows-based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
• Methods and techniques of financial modeling and analysis
• Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
• Healthcare industry-specific terms and healthcare-related data types and structures, including member, claims, clinical, and provider types
• National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
• Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
• Ability to:
• Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
• Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
• Translate data into understandable information and deliver solutions that improve business processes
• Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
• Interpret and apply rules, regulations, policies, procedures, and guides
• Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders
• Education and Experience:
• Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
• A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

Other information

• We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

Compensation information

• Zone 1 Pay Range: $125,000 - $140,000. Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
• Zone 2 Pay Range: $118,000 - $132,000. Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas listed. You can reach out to [e-mail], and a member from our Talent Acquisition team will be in touch.

The hiring ranges represent a good-faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

Our benefits

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

About us

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.