Risk Adjustment Predictive Analytics Pro

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

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.