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