Senior Healthcare Data Analyst (Provider Analytics)

Provider Reimbursement Analyst

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Performs routine to moderately complex financial analyses to support provider contracting strategies for Professional Providers. Begins to gain exposure to Institutional Provider analytics. Collaborates with Network Management and senior analysts to deliver actionable insights that support business initiatives and decision-making. Maintains market intelligence and contributes to the evaluation of network performance.

Responsibilities:

• Analyze utilization, cost, contract valuation, competitive benchmarks, and financial impact data as directed. Translate findings into clear, actionable insights to support decision-making.
• Update and validate provider rate loading to ensure accuracy and compliance with contract terms.
• Provide tactical support to senior analysts by extracting and preparing data for robust quantitative analysis.
• Extract and manipulate data from multiple sources to develop analytic datasets. Present findings in a clear and concise format.
• Support rate strategy development and analyze emerging payment models to inform contracting decisions.
• Assist in forecasting contract rates and utilization trends. Build basic financial models and 'what-if' scenarios using claims data.
• Support fee schedule development and quality checks. Maintain clear documentation of updates and build processes.
• Performs other duties as assigned.

Qualifications:

• Provider Reimbursement Analyst II
• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 2 years of experience as a Provider Reimbursement Analyst or equivalent health care administration experience, preferably in managed care.
• Provider Contracting/Network Management experience a plus.
• Intermediate Microsoft Office Excel, Word, Access, and PowerPoint skills.
• Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports preferred.
• Experience working with relational databases.
• Knowledge of provider contracting.
• Provider Reimbursement Analyst III
• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 3-4 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting/Network Management.
• Intermediate Microsoft Office Excel, Word, Access, and PowerPoint
• Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports preferred.
• Ability to quickly learn and use software business intelligence tools.
• Experience working with relational databases.
• Senior Provider Reimbursement Analyst
• Bachelor's degree in business or healthcare administration, finance or related field.
• 5 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting/Network Management.
• Advanced financial analysis skills including forecasting and payment modeling.
• Advanced computer skills including Excel, Word, Access, and PowerPoint.
• Ability to utilize SAS programming language in assigned analysis.
• Ability to quickly learn and use software BI tools.
• Experience working with relational databases.
• Ability to apply technical skills and operational knowledge to produce actionable results and analysis.