Remote Director, Provider Analytics & Network Strategy

Wellsense-Health-Plan; United States; Remote; USD 139,000 - 201,000; Full time

Benefits offered by this job

Remote work

Competitive salary

Excellent benefits

Job summary

WellSense Health Plan in the Boston area seeks a Director of Provider Analytics to lead analytics supporting provider contracting, network strategy, and network adequacy. This role translates provider, claims, membership, and network data into actionable insights for contracting decisions and regulatory compliance.

The Director also oversees network adequacy analysis and CHIA reporting using Quest software, ensuring access and adequacy.

Qualifications

• 8+ years of health insurance analytics or related functions.
• Experience with provider network adequacy analysis and regulatory reporting.
• Experience supporting Commercial/ACA, Medicaid, or multiple lines of business.
• Experience with Quest network adequacy software, or similar platforms.

Responsibilities

• Lead analytics supporting provider contracting, reimbursement strategy, and provider negotiations.
• Develop financial models to evaluate reimbursement proposals, contract terms, and alternative negotiation scenarios.
• Analyze provider utilization, reimbursement, referral patterns, and performance to identify key trends.
• Assess provider reimbursement relative to internal and external benchmarks.
• Quantify the financial impact of proposed contract and network changes across products and markets.
• Provide Network Strategy leadership with actionable insights to support contracting decisions.
• Lead network adequacy analysis, monitoring, and reporting using Quest software.
• Oversee CHIA data submission processes, including data preparation and validation.
• Provide analytics supporting network development and provider recruitment.
• Develop analytics and reporting to evaluate provider performance across cost and utilization.

Skills

Healthcare analytics

Provider reimbursement

SQL

SAS

Project management

Negotiation

Regulatory reporting

Communication

Education

Bachelor’s degree in actuarial science or related

Master’s degree preferred

Tools

Quest software

SQL

SAS

Job description

WellSense Health Plan in the Boston area seeks a Director of Provider Analytics to lead analytics supporting provider contracting, network strategy, and network adequacy. This role translates provider, claims, membership, and network data into actionable insights for contracting decisions and regulatory compliance.

The Director also oversees network adequacy analysis and CHIA reporting using Quest software, ensuring access and adequacy.