Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; San Antonio (TX); Remote; USD 77,000 - 125,000; Full time

Job summary

A leading company is seeking a Senior Analyst in Healthcare Analytics to join their Risk Adjustment Actuarial team. This role involves analyzing healthcare data, developing performance reports, and supporting strategic decisions. Candidates should have a strong background in data management and healthcare analytics, with a Bachelor's degree in a relevant field and extensive experience in SQL and data visualization tools.

Qualifications

• 5-7 years in complex database and data management responsibilities.
• Healthcare experience in quantifying and analyzing financial/utilization metrics.
• Advanced SQL knowledge.

Responsibilities

• Responsible for Program Valuation on Molina's Risk Adjustment Actuarial team.
• Research, analysis, and modeling of healthcare claims data.
• Develop and present ROI and program performance reports.

Skills

Data analysis

Healthcare analytics

SQL

Excel

Data visualization

Forecasting

Root cause analysis

Project management

Education

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

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

Tools

Power BI

Tableau

Job description

Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

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Job Description

Job Summary

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 healthcare intervention program performance. Develops and presents ROI, incremental conditions captured, and other program performance reports, including forecasts and recommendations. Performs strategic analysis and planning, coordinating across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Analyzes data 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, SSIS, and other tools.
• Reporting includes program performance metrics, risk score and revenue impact, tracking strategic/scorable action items, forecasts, and deep dives to improve financial results.
• Ownership of root cause analysis to maintain data integrity and minimize discrepancies.
• Creating databases and dashboards for monitoring, tracking, and trending; applying automation as needed.
• Forecasting risk adjustment intervention program values.
• Proficiency in running risk models for CMS Medicare Advantage, HHS Commercial ACA, Medicaid CDPS, and others.
• Strong attention to detail, understanding data structures and programming.
• Performing financial analysis to support healthcare management and decision-making.
• Applying data storage and sharing best practices.
• Converting data into insights to support strategic decisions.
• Developing reports and analyses for senior management, communicating results clearly.
• Gathering and documenting report requirements, conducting peer reviews, and consulting end-users.
• Practicing judgment, consulting experts, and utilizing resources effectively.
• Managing multiple projects and delivering results in a fast-paced environment.

Job Qualifications

Required Education

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

Required Experience

• 5-7 years in complex database and data management responsibilities.
• 5-7 years analyzing financial/performance metrics.
• Healthcare experience in quantifying and analyzing financial/utilization metrics.
• Advanced SQL knowledge.
• Proficient 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.
• Investigative skills in risk adjustment initiatives, score lift, conditions captured, and program value.
• In-depth analysis and corrective action planning.
• Use of healthcare analytics and predictive modeling.
• Forecasting program value and population trends.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I.
• Experience with multiple data systems, models, and BI tools.

To all current Molina employees: Apply through the intranet job listing.

Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range

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

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: IT Services and Consulting