Sr. Provider Financial Analyst (Claims Data Modeling)

Supports and validates provider contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Conducts unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies. Performs other duties as assigned., The Provider Financial Analyst is responsible for analyzing provider reimbursement, new methodology impact, and financial trends to support organizational goals and optimize provider network performance. This role partners with Finance, Provider Contracting, Network Management, and Operations teams to evaluate financial impacts of provider agreements, identify opportunities for cost savings, and provide actionable insights through data analysis and reporting. The ideal candidate has at least five years of financial analysis experience, preferably within healthcare, managed care, provider contracting, or reimbursement environments., Financial Analysis & Reporting

• Analyze provider reimbursement data, medical expense trends, and financial performance metrics.
• Develop, maintain, and enhance financial models to evaluate provider contracts and payment methodologies.
• Prepare monthly, quarterly, and annual financial reports related to provider spending and network performance.
• Monitor key performance indicators (KPIs) and identify trends, risks, and opportunities for improvement.
• Perform variance analysis and explain financial results to leadership and business partners.
• Evaluate financial impacts of proposed provider contracts, amendments, and reimbursement changes.
• Model methodology changes to monitor organizational impact.
• Collaborate with Network Management teams to ensure compliance with organizational objectives.

Data Management & Analytics

• Extract, validate, and analyze large datasets from claims, provider, and financial systems.
• Utilize analytical tools to identify utilization patterns, cost drivers, and reimbursement trends.
• Develop dashboards and reporting solutions to improve visibility into provider financial performance.
• Ensure data accuracy and integrity across analyses and reporting.

Business Partnership

• Collaborate with Finance, Actuarial, Medical Management, Network Operations, and Compliance teams.
• Present findings and recommendations to management and stakeholders.
• Support budgeting, forecasting, and strategic planning activities.
• Participate in special projects, audits, and financial initiatives as needed.

• Bachelor’s degree or equivalent experience in related field.
• 5 years of work experience beyond degree.
• Experience with SQL, Power BI, Tableau, SAS, or other analytical tools.
• Healthcare Industry experience., * Experience analyzing healthcare claims, provider contracts, reimbursement methodologies, or medical cost data.
• Familiarity with value-based care models and alternative payment methodologies.
• Advanced proficiency in Microsoft Excel, including pivot tables, complex formulas, and financial modeling.
• Experience working with large datasets and data visualization/reporting tools.
• Strong analytical, problem-solving, and critical-thinking skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office, on average, 3 days per week.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position’s scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We’re a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It’s our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.