Senior Healthcare Analyst

Medica; Madison (WI); Híbrido; USD 70.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental benefits

Vision benefits

PTO

Holidays

401K contributions

Volunteer time off

Caregiver services

Descripción de la vacante

Medica, a nonprofit health plan, is seeking a Senior Healthcare Analyst in Madison, WI. This onsite-friendly role partners with operations to transform healthcare data into actionable insights, supporting reimbursement, contracting, and quality programs; the right candidate will bridge analytics with business outcomes.

The position requires 5+ years in healthcare data/claims, strong SQL and Excel, and experience with provider reimbursement.

Formación

• Bachelor's degree or equivalent in related field.
• 5+ years of work experience beyond degree.
• 3+ years of experience in provider reimbursement, provider network management, or provider contracting.
• 3+ years of experience with healthcare claims and payment operations.
• Knowledge of facility and professional reimbursement methodologies.
• Advanced SQL skills
• Advanced Microsoft Excel skills

Responsabilidades

• Analyze medical, pharmacy, claims, provider, and operational datasets to identify trends, risks, and improvement opportunities.
• Develop executive dashboards, scorecards, and KPI reporting.
• Deliver financial analyses and reporting (recurring and adhoc) that support provider contracting, reimbursement, and actuarial strategies
• Support efforts to improve data quality, transparency, and accessibility of provider payment, contract, and claims data

Conocimientos

Strong analytical skills

Organizational skills

Problem-solving

Educación

Bachelor's degree or equivalent in related field

Herramientas

SQL

Microsoft Excel

Descripción del empleo

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Senior Healthcare Analyst serves as a strategic partner supporting health plan operations through analytics, reimbursement expertise, and cross-functional collaboration. This role transforms complex healthcare data into actionable business insights, supports payment integrity and provider reimbursement initiatives, develops scalable reporting solutions, and partners with operational leaders to improve quality, efficiency, and financial performance.

The ideal candidate combines strong analytical skills with deep knowledge of healthcare operations, reimbursement methodologies, provider contracting, and health insurance business processes.

Key Accountabilities

• Analyze medical, pharmacy, claims, provider, and operational datasets to identify trends, risks, and improvement opportunities.
• Develop executive dashboards, scorecards, and KPI reporting.
• Deliver financial analyses and reporting (recurring and adhoc) that support provider contracting, reimbursement, and actuarial strategies
• Support efforts to improve data quality, transparency, and accessibility of provider payment, contract, and claims data

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience beyond degree
• 3+ years of work experience in provider reimbursement, provider network management, or provider contracting
• 3+ years of experience with healthcare claims and payment operations
• Knowledge of facility and professional reimbursement methodologies
• Advanced SQL skills
• Advanced Microsoft Excel skills
• Strong analytical, organizational, and problem-solving skills

Preferred Qualifications

• Familiarity with CMS payment rules, Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Prospective Payment System (OPPS), Inpatient Prospective Payment System (IPPS), and Ambulatory Surgery Center (ASC) payment methodologies.
• Experience with Power BI, QlikSense, or similar business intelligence tool

The ideal candidate will have experience working with provider contracts and reimbursement structures, including payment methodologies for both facility and professional providers. A strong understanding of how contractual reimbursement terms impact claims adjudication and payment accuracy is highly preferred.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, or St. Louis, MO.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US:

Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.