Senior Analyst, Provider and Claim Data & Analytics (Remote)

Job Description

Molina Healthcare of Nebraska is hiring for a Senior Analyst, Provider and Claim Data & Analytics. This role is remote for those within the United States.

Highly Qualified Candidates Will Have the Following Experience-

• Medicaid and managed care
• Claims and coding experience. A coder certification is a plus but not required
• Ability to support network adequacy and provider data integrity by digging into provider claims and lead provider data clean-up efforts.
• Root cause analysis
• Strong SQL skills, including writing their own formulas or queries along with strong Excel skills
• Be a self-starter who can jump in where needed, pivot when required, all while having strong attention to detail

Essential Job Duties

• Provides senior level analyst support for data analysis and reporting activities. Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance. Generates data-related insights that support strategic and operational decision-making and cost-containment. Designs and delivers reporting, analytics, and data solutions across business and healthcare domains, including claims, utilization, finance, and other business areas. Partners with stakeholders to define requirements, develop scalable reporting and data processes, and apply advanced analytical techniques to identify trends, forecast outcomes, and drive business performance. Supports projects, regulatory requests, and initiatives that improve data quality, reporting workflows, and process efficiencies.
• Analyzes complex datasets from multiple sources to identify trends, patterns, risks, and opportunities.
• Designs, develops, and maintains reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS), that support utilization analysis, cost-containment, and operational performance.
• Translates business needs into reporting and analytical requirements; partners with stakeholders to deliver actionable insights.
• Facilitates healthcare data analysis, including data related to claims, pharmacy, lab, utilization, cost, and other areas.
• Develops and maintains data processes for extraction, transformation, validation, and integration.
• Ensures data accuracy, integrity, and consistency through quality assurance and validation processes.
• Creates forecasts, models, and recommendations based on statistical analysis and business context.
• Organizes, documents, and maintains datasets and reporting workflows across multiple business areas.
• Consolidates research and analysis into clear summaries and recommendations for business stakeholders.
• Supports regulatory, contractual, and enterprise reporting requirements, including state mandated submissions.
• Identifies and implements enhancements or fixes to existing reports and reporting processes.
• Collaborates with cross-functional teams to define reporting requirements and maintain project/report timelines.
• Documents methodologies, reporting processes, and business requirements.
• Identifies and drives process improvements, standardization, and automation opportunities.
• Leads or supports projects, including timeline management, requirements gathering, and deliverable execution.
• Presents findings and recommendations to leadership and cross-functional teams.
• Supports regulatory, audit, and ad hoc data requests as needed.
• Provides training and support to new and existing data analysis team members.

Required Qualifications

• At least 4 years of experience in data analysis, reporting, or healthcare analytics, or equivalent combination of relevant education and experience.
• Analytical problem-solving skills, including ability to interpret complex datasets, identify patterns, and translate findings into actionable insights.
• Technical proficiency with SQL, Excel, and reporting/analytics tools, and ability to learn new technologies quickly.
• Experience with healthcare analytics (e.g., claims, utilization, cost containment, medical economics).
• Experience working with complex datasets/provision of data analysis and insights.
• Experience with healthcare utilization metrics, medical cost analysis, and performance indicators.
• Attention to detail, accuracy in data validation, report development, and documentation.
• Ability to work cross-functionally across a highly matrixed organization.
• Effective verbal, written, and interpersonal communication skills, and ability to collaborate with cross-functional teams to clarify requirements and present data-related findings and solutions.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Experience with SQL Server Reporting Services (SSRS), Crystal Reports, MedInsight, Power BI, relational databases or similar tools.
• Experience with customer relationship management (CRM) systems (e.g., Salesforce).
• Experience with Extract, Transform, Load (ETL) tools such as SQL Server Integration Services (SSIS) and data warehousing concepts.
• Familiarity with cloud data platforms (e.g., Azure data lakes) and business intelligence (BI) tools.
• Experience supporting regulatory reporting and healthcare payer systems (e.g., QNXT or similar platforms).
• Familiarity with predictive modeling concepts and trend forecasting.
• Project management experience.
• Microsoft certification or similar technical credentials.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V