Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Houston (TX); 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. The role involves analyzing complex healthcare data, developing reports, and providing insights to improve healthcare intervention programs. Ideal candidates will have a strong background in data analysis, SQL, and healthcare financial metrics, with a focus on delivering actionable insights to support strategic decision-making.

Qualifications

• 5-7 years of experience in complex database management.
• Healthcare experience in analyzing financial metrics.
• Proficiency in SQL and data visualization tools.

Responsibilities

• Analyze complex healthcare claims and financial data.
• Develop and present performance reports and forecasts.
• Coordinate across business units for strategic analysis.

Skills

Advanced SQL

Data Analysis

Healthcare Financial Metrics

Data Visualization

Attention to Detail

Education

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

Tools

Power BI

Tableau

Databricks

SQL Server

Job description

Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

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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 work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis, and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).

Knowledge/Skills/Abilities

• Compiling and organizing healthcare data using Databricks, Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic/programming tools as needed.
• Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, forecasts, and regular deep dives to drive financial improvement.
• Ownership of root cause analysis to maintain high data integrity and minimize discrepancies and gaps.
• Create databases and dashboards for monitoring, tracking, and trending, applying automation as appropriate.
• Complete analysis and forecasting of risk adjustment intervention program values.
• Develop proficiency in running all applicable risk models, including CMS models for Medicare Advantage, HHS model for Commercial ACA, CDPS model for Medicaid, and others as needed.
• Strong attention to detail and knowledge of data structures and programming.
• Perform financial analysis to support healthcare management and decision-making.
• Understand and apply data storage and sharing best practices.
• Convert data into understandable insights to support strategic investments.
• Research and develop reports and analyses for senior management, communicating results effectively.
• Gather and document report/programming requirements, use peer review and end-user feedback to reduce errors.
• Exercise judgment independently, consult experts as needed, and utilize resources to critique results.
• Manage multiple projects and deliver results on time in a fast-paced, changing 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.
• 5-7 years of experience in quantifying, measuring, and analyzing healthcare financial/performance metrics.
• Healthcare experience in quantifying, measuring, and analyzing healthcare utilization and financial metrics.
• Advanced SQL knowledge.
• Proficiency in Excel and visualization tools such as Power BI, Tableau, or similar.

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 risk adjustment issues, suggest corrective actions, and perform in-depth analyses using healthcare analytics and predictive modeling.
• Forecasting program value and population trends to support finance, pricing, and actuarial functions.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I preferred.
• Experience with multiple data systems, models, data modeling, and BI tools.

Current Molina employees should apply via the intranet. Molina Healthcare offers competitive benefits. We are an EOE M/F/D/V.

Pay Range: $77,969 - $125,000 / ANNUAL. Actual compensation varies 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