Senior Healthcare Data Analyst, Provider Network - Kelsey Seybold, Pearland, TX

Optum; Pearland (TX); Presencial; USD 92 000 - 164 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive benefits package

Equity stock purchase

401k contribution

Resumo da oferta

Kelsey-Seybold Clinic, part of the Optum family, seeks a Sr. Data Analyst to evaluate medical costs, utilization, and provider performance across Texas. You will partner with finance, actuarial, and clinical teams to inform contracts and network strategy.

The role emphasizes AI-enabled analytics, data governance, and regulatory compliance. The position requires 10+ years in health care or health plans and expertise with EPIC, SQL, and data management.

Qualificações

• Bachelor's degree or equivalent work experience.
• Experience with EPIC and SQL servers.
• 10+ years of Health Care or Health Plan experience.
• Knowledge of CMS rules and regulations and managed care payment methodologies.
• Experience with Power BI, Tableau and data services.

Responsabilidades

• Analyze medical costs, utilization, and provider network performance.
• Collaborate with payor strategy, finance, actuarial and operations.
• Support regulatory compliance (TDI and CMS) and network adequacy.
• Leverage AI-enabled analytics to improve data efficiency and insights.

Conhecimentos

SQL servers

Power BI

Tableau

EPIC

Data management

Excel

CMS rules

AI-enabled analytics

Regulatory compliance

Provider/network performance

Formação académica

Bachelor's degree or equivalent work experience

Ferramentas

EPIC

SQL

SAP

Power BI

Tableau

Descrição da oferta de emprego

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Sr. Data Analyst supports financial and operational performance across Commercial, Medicare Advantage and ACA Marketplace products within the Texas market. This role focuses on analyzing medical costs, utilization, and provider network performance to drive strategic decision-making, ensure regulatory compliance (TDI and CMS), and optimize financial outcomes. The analyst partners closely with payor strategy, finance, actuarial, and clinical operations to evaluate provider performance, support contract negotiations, and ensure network adequacy while balancing cost, access, and quality. This role is expected to leverage advanced analytics and emerging AI-enabled tools to improve data efficiency, enhance predictive insights, and support informed financial and network strategy decisions while ensuring data governance and regulatory compliance You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Preferred Qualifications

• Bachelor's degree or equivalent work experience
• EPIC
• 10+ years of Health Care or Health Plan experience
• Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services. Knowledge of CMS rules and regulations, Managed Care payment methodologies, proficient in MS office products, Power BI, Tableau and process improvement methodology
• Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures
• Experience applying AI-enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL-based environments) to support healthcare financial analysis and decision-making
• Healthcare & Texas Market Knowledge with a solid understanding of Medicare Advantage Reimbursement and risk adjustment, ACA Marketplace dynamics, capitation and value-based models. Familiarity with: Texas Department of Insurance (TDI) requirements, including network adequacy, CMS regulations and compliance requirements. Understanding of: Provider reimbursement methodologies (e.g., % of Medicare, DRG, case rates)
• Proven excellent written and verbal communication skills, solid analytical and problem-solving abilities and high attention to detail

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.