Senior Analyst, Data & Analytics - No Surprises Act/Provider Reimbursements/SQL - Remote

Overview

The Senior Analyst, OON Dispute Analytics and Reporting supports the out-of-network (OON) provider liability operating model by building the analytics, reporting, and market intelligence used to guide negotiation strategy, arbitration positioning, QPA payment accuracy, and overall IDR performance. This 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 position integrates data from internal and external sources, develops reporting dashboards, and produces actionable insights by translating financial and operational information into recommendations that improve dispute outcomes.

Responsibilities

• Analyze complex datasets from multiple sources to identify trends, patterns, risks, and opportunities, tracking performance across pre-IDR negotiation, open negotiation, arbitration, settlement, and post-award outcomes.
• Design, develop, and maintain reports, dashboards, and data solutions using tools such as Structured Query Language (SQL), Microsoft Excel, and SQL Server Reporting Services (SSRS); produce standard and ad hoc reporting for Director, Network Strategy, Finance, Operations, and health plan stakeholders.
• Translate business needs into reporting and analytical requirements and partner with stakeholders to deliver actionable insights.
• Combine data from internal and external sources, including claims, QPA data, IDR case tracking, negotiation records, provider data, financial reporting, market benchmarks, and third-party data sources.
• Perform healthcare data analysis, including claims, utilization, and cost data; leverage external data sources to inform trends.
• Develop and maintain data processes for extraction, transformation, validation, and integration.
• Ensure data accuracy, integrity, and consistency through quality assurance and validation; reconcile data across systems and identify gaps, inconsistencies, and quality issues.
• Partner with IT, Finance, Medical Economics, Actuary, Operations / Shared Services, and external vendors to improve data availability and reporting automation, including collaboration with the provider dispute intake team.
• Produce and monitor 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
  • Support target-setting and performance management for dispute-related KPIs
  • Establish reporting views by market, state, provider, specialty, and arbitrator
• Develop financial views that quantify dispute exposure, settlement impact, arbitration outcomes, and avoided cost; translate financial outputs into actionable insights for negotiation strategy and health plan playbooks.
• Build visual dashboards summarizing OON dispute performance, financial impact, and strategic opportunities; create executive-ready reporting materials for leadership reviews and governance forums; enable drill-down from enterprise-level performance to market, provider, specialty, and case-level detail.
• Present findings and recommendations to leadership and cross-functional teams.

Requirements

• 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 and governance experience.
• Stakeholder communication and influence, with the ability to translate detailed data into clear business insights and recommendations.
• Proficiency with data visualization and analytics tools, such as Tableau, Power BI, or 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.

Compensation & Benefits

• Pay Range: $59,810 - $129,589 / ANNUAL
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Location

• Not specified in the posting.