Senior Risk Adjustment Predictive Analytics Lead

Molina Healthcare; United States; Remote; USD 72,000 - 157,000; Full time

Job summary

Molina Healthcare is seeking a lead analyst to support enterprise risk adjustment predictive analytics. You will design and develop tracking systems for risk scores across interventions and markets, and develop QA reporting modules for Medicaid, Marketplace, and MMP lines.

The role requires strong SQL (T-SQL, SSIS/SSRS), Power BI expertise, and experience with healthcare quality metrics, with the ability to translate data insights into actionable business outcomes.

Qualifications

• 4+ years of experience writing complex SQL queries, including T-SQL, SSIS, SSRS, and Power BI, with predictive modeling in healthcare quality/HEDIS forecasting.
• Analytical mindset with strong attention to detail and problem-solving skills.
• Experience working with complex data to quantify, measure, and analyze financial/performance metrics.
• Experience with Microsoft Azure, AWS, or Hadoop.

Responsibilities

• Provide lead level analyst support for enterprise risk adjustment predictive analytics.
• Design and lead development of tracking systems for risk scores across interventions and markets.
• Develop QA ad-hoc and automated reporting modules for risk adjustment (Medicaid, Marketplace, MMP).
• Create automated suspect and target/ranking engine for all lines of business.
• Analyze managed care data (claims, pharmacy, labs, financial data) for risk score, revenue, and cost insights.
• Perform data analysis, mining, scrubbing, and root-cause analysis to extract meaningful insights.

Skills

SQL

T-SQL

SSIS

SSRS

Power BI

Predictive modeling

Data analysis

Cloud platforms

Communication

Cross-functional collaboration

Tools

Databricks SQL

Job description

Molina Healthcare is seeking a lead analyst to support enterprise risk adjustment predictive analytics. You will design and develop tracking systems for risk scores across interventions and markets, and develop QA reporting modules for Medicaid, Marketplace, and MMP lines.

The role requires strong SQL (T-SQL, SSIS/SSRS), Power BI expertise, and experience with healthcare quality metrics, with the ability to translate data insights into actionable business outcomes.