Job Summary
The Senior Analyst, OON Dispute Analytics and Reporting, supports the
out-of-network (OON) provider liability operating model by developing the
analytics, reporting, and market intelligence needed to inform the negotiation
strategy, arbitration positioning, QPA payment accuracy, and overall IDR
performance. The role reports to the Director, Provider Dispute Strategy, and
serves as the primary analytics partner for pre-IDR negotiation, federal NSA
IDR, state-based dispute processes, and provider-level OON liability management.
The Senior Analyst is responsible for integrating data from multiple internal
and external sources, building reporting dashboards, producing actionable
insights, and translating financial and operational data into recommendations
that support improved dispute outcomes. This role requires strong data
management, healthcare finance, reimbursement, and reporting capabilities, as
well as the ability to connect claim-level detail, dispute outcomes, provider
behavior, QPA performance, market benchmarks, and financial reporting trends.
The role 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.
Job Duties
Analyzes complex datasets from multiple sources to identify trends, patterns,
risks, and opportunities. Tracks performance across pre-IDR negotiation, open
negotiation, arbitration, settlement, and post-award outcomes.
Designs, develop, and maintain reports, dashboards, and data solutions using
tools such as Structured Query Language (SQL), Microsoft Excel, and SQL
Server Reporting Services (SSRS). Produces standard and ad hoc reporting for
Director, Network Strategy, Finance, Operations and health plan stakeholders.
Translates business needs into reporting and analytical requirements; partner
with stakeholders to deliver actionable insights.
Combines data from multiple internal and external sources, including claims,
QPA data, IDR case tracking, negotiation records, provider data, financial
reporting, market benchmarks, and third-part data sources.
Performs healthcare data analysis, including claims, utilization, and cost
data. Leverages external data sources as well to inform trends.
Develops and maintains data processes for extraction, transformation,
validation, and integration.
Ensures data accuracy, integrity, and consistency through quality assurance
and validation processes. Reconciles data across systems and identifies gaps,
inconsistencies, and quality issues.
Partners with IT, Finance, Medical Economics, Actuary and Operations / Shared
Services and external vendors to improve data availability and reporting
automation, specifically collaborating with the provider dispute intake team
Produces and monitors key performance metrics, including: Percent of cases
settled pre-IDR, averaged negotiated rate versus initial offer, percent of
negotiations escalated to IDR, provider acceptance rate, IDR award versus
QPA, IDR win rate, win rate by arbitrator, etc. Supports target-setting and
performance management of dispute-related KPIs; establishes reporting views
by market, state, provider, specialty, and arbitrator.
Develops financial views that quantifies dispute exposure, settlement impact,
arbitration outcomes and avoided cost; translates financial reporting outputs
into actionable insights for negotiation strategy and health plan playbooks
Develops visual dashboards that summarize OON dispute performance, financial
impact, and strategic opportunities; creates executive-ready reporting
materials for leadership reviews and governance forums; develops drill-down
capability from enterprise-level performance to market, provider, specialty
and case-level detail
Presents findings and recommendations to leadership and cross-functional
teams.
Job Qualifications
At least 4 years of experience in data analysis, reporting, or analytics, or
equivalent combination of relevant education and experience.
Strong experience with Structured Query Language (SQL), relational databases,
and Microsoft Excel.
Experience with reporting and visualization tools (e.g., SQL Server Reporting
Services (SSRS) or similar).
Experience working with complex datasets, including claims, provider,
reimbursement, and financial data
Demonstrated ability to manage multiple priorities and deliver on deadlines
Advanced data analysis and critical thinking, with experience developing
dashboards, scorecards, recurring reports, and executive-facing analytics
Data quality & governance
Stakeholder communication & influence, with ability to translate detailed
data into clear business insights and recommendations
Proficiency with data visualization and analytics tools, such as Tableau,
Power BI, or other similar platforms
PREFERRED QUALIFICATIONS:
Experience with No Surprises Act IDR, state-based provider dispute processes,
OON claims, or provider payment disputes
Knowledge of QPA methodology, provider reimbursement, Medicare-based pricing,
commercial benchmarks, or payer claims adjudication
Experience combining internal data with external market data sources
Advanced SQL, Python R, or Alteryx skills
Experience with financial reporting, medical cost reporting, or healthcare
P&L analysis
Experience supporting provider contracting, network strategy, medical
economics, or payment integrity teams
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