Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Des Moines (IA); Remote; USD 77,000 - 125,000; Full time

Job summary

A leading company in healthcare analytics is seeking a Sr Analyst to join their Risk Adjustment Actuarial team. This role involves analyzing healthcare data, developing reports, and providing strategic insights to improve program performance. Candidates should have a strong background in data management and healthcare metrics, with a Bachelor's degree in a relevant field.

Qualifications

• 5-7 years of complex database and data management responsibilities.
• Experience in quantifying and analyzing healthcare financial metrics.
• Advanced SQL knowledge and proficiency in Excel.

Responsibilities

• Responsible for Program Valuation on Molina's Risk Adjustment Actuarial team.
• Conduct research, analysis, and modeling of healthcare claims data.
• Develop and present ROI analyses and other reports.

Skills

Data analysis

Healthcare metrics

SQL

Data management

Financial analysis

Forecasting

Attention to detail

Data visualization

Education

Bachelor's Degree in Finance

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Tools

Power BI

Tableau

Databricks

Spark SQL

SQL Server

SSIS

Job description

Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

This Sr. Analyst, Healthcare Analytics role will be responsible for Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis, and modeling of healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate program performance. Develops and presents ROI analyses, incremental conditions captured, and other reports including forecasts, making recommendations based on findings. Performs strategic analysis and planning across business units on Risk Adjustment Program Valuation and SAIs to meet business needs, including analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).

Knowledge/Skills/Abilities

• Compiling and organizing healthcare data using tools like Databricks, Spark SQL, SQL Server, SSIS, and other analytic tools
• Reporting on program performance metrics, risk scores, revenue impact, and strategic action items
• Ownership of root cause analysis to ensure data integrity
• Creating databases and dashboards for monitoring and trending, with automation as needed
• Forecasting risk adjustment program values
• Proficiency in risk models for Medicare Advantage, Commercial ACA, Medicaid, etc.
• Strong attention to detail and knowledge of data structures and programming
• Financial analysis to support healthcare management decisions
• Applying data storage and sharing best practices
• Transforming data into insights for strategic investments
• Developing reports and communicating results effectively to senior management
• Gathering and documenting report requirements, peer review, and end-user consultation
• Practicing independent judgment, consulting experts, and managing multiple projects in a fast-paced environment

Job Qualifications

Required Education

Bachelor's Degree in Finance, Economics, or Computer Science

Required Experience

• 5-7 years of complex database and data management responsibilities
• Experience in quantifying and analyzing healthcare financial and utilization metrics
• Advanced SQL knowledge
• Proficiency in Excel and visualization tools like Power BI or Tableau

Preferred Education

Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

• Experience in Medical Economics and knowledge of performance indicators
• Ability to identify and investigate complex issues in risk adjustment initiatives
• Experience with healthcare analytics, predictive modeling, and population trend analysis
• Healthcare or financial analyst experience preferred
• Experience with multiple data systems and models, data modeling, and BI tools

Current Molina employees interested in this position should apply through the intranet. Molina offers competitive benefits. We are an EOE M/F/D/V.

Pay Range: $77,969 - $125,000 annually. Actual compensation may vary based on location, experience, education, and skills.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• IT Services and IT Consulting