Payer Analytics Consultant (Defined Term)

Consult; California; Hybrid; USD 118,000 - 140,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

401(a) Retirement Plan

457 Deferred Compensation Plan

Paid Holidays

Job summary

Central California Alliance for Health is seeking a Payer Analytics Consultant (Defined Term) in the Payment Strategy Department. The role focuses on building payer models, conducting financial analyses, and coordinating with finance, network management, operations, and clinical teams to ensure accurate reimbursement strategies.

The ideal candidate is technically strong in data interpretation, has experience with provider reimbursement methodologies, and communicates complex concepts clearly to

Qualifications

• Bachelor’s degree required in a relevant field.
• Minimum of three years’ experience performing financial healthcare reimbursement analysis; Master’s degree may substitute for two years.
• Experience working with payer financial modeling and reimbursement strategies.

Responsibilities

• Designs and validates managed care payer models and analyzes feasibility of reimbursement methodologies.
• Performs moderately complex financial analyses to support payer reimbursement outcomes.
• Coordinates with internal and external stakeholders to achieve payer reimbursement objectives.

Skills

Financial modeling

Payer reimbursement

Provider payment methodologies

SQL

Tableau

Data interpretation

Excel (pivot tables)

Education

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

Tools

SQL

Tableau

Excel

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration.That’swhy we do not use AI or automated systems toreview applications. Every application is reviewed bya real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

We have an opportunity to join the Alliance as the Payer Analytics Consultant (Defined Term) in the Payment Strategy Department.

This Defined Term position is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This Defined Term role is a fully benefited position.

This position can be filled within any of our Alliance service areas, or remotely within the Pacific, Mountain and Central time zones.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Payment Strategy Director, this position:

• 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 - $140,00
  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
• And many more

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.

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

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at ourFact Sheet.

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.