Talent.com
Payer Analytics Consultant
Payer Analytics ConsultantCentral California Alliance for Health • Scotts Valley, California, United States
Payer Analytics Consultant

Payer Analytics Consultant

Central California Alliance for Health • Scotts Valley, California, United States
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
  • [job_card.part_time]
[job_card.job_description]

We have an opportunity to join the Alliance as a Payer Analytics Consultant in the Payment Strategy Department. There are two positions that can be filled as a Payer Analytics Consultant or Senior Payer Analytics Consultant level.

This position can be filled remotely for those living in California.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Payment Strategy Director, this position :

  • Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
  • Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
  • Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives

ABOUT THE TEAM

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs.

THE IDEAL CANDIDATE

  • Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development.
  • Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy.
  • Collaborative and solutions-focused, working effectively across departments - including finance, provider network management, operations, and clinical teams - to align analytics with business goals.
  • A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences.
  • Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment.
  • Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies.
  • WHAT YOU'LL NEED TO BE SUCCESSFUL

    To read the full position description and list of requirements, click here.

  • Knowledge of :
  • Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
  • Methods and techniques of financial modeling and analysis
  • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
  • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
  • National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
  • Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
  • Ability to :

  • Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
  • Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
  • Translate data into understandable information and deliver solutions that improve business processes
  • Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
  • Interpret and apply rules, regulations, policies, procedures, and guides
  • Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders
  • Education and Experience :

  • Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field
  • A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  • OTHER INFORMATION

  • We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
  • The full compensation range for this position is listed by location below.

    The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

    Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles area, San Diego area

    Typical areas in Zone 2 : Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

    Zone 1 (Monterey, San Benito and Santa Cruz)

    $97,920—$156,686 USD

    Zone 2 (Mariposa and Merced)

    $89,108—$142,584 USD

    OUR BENEFITS

    Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
  • ABOUT US

    We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

    Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet .

    The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

    At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

    [job_alerts.create_a_job]

    Consultant • Scotts Valley, California, United States

    [internal_linking.similar_jobs]
    Payer Analytics Consultant

    Payer Analytics Consultant

    Central California Alliance for Health • Scotts Valley, CA, United States
    [job_card.full_time] +1
    We have an opportunity to join the Alliance as a Payer Analytics Consultant in the Payment Strategy Department.There are two positions that can be filled as a Payer Analytics Consultant or Senior P...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Payments Strategy & Analytics

    Director of Payments Strategy & Analytics

    Visa • Mountain View, CA, United States
    [job_card.full_time]
    A global payments technology leader in Mountain View is seeking a Director for Visa Consulting and Analytics.This role involves leading consulting projects, managing client relationships, and utili...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Payroll Analyst

    Payroll Analyst

    Picarro • Santa Clara, CA, United States
    [job_card.full_time]
    As the Payroll Analyst, you will assist with day-to-day payroll operations and the company's bi-weekly payroll processing. This position will ensure all payroll activity is processed accurately and ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Senior Domain Consultant - Capital Markets

    Senior Domain Consultant - Capital Markets

    Forhyre • Sunnyvale, CA, US
    [job_card.full_time]
    We are seeking a highly experienced Senior Domain Consultant with expertise in Capital Markets and strong knowledge of Collateral management for Derivatives product lines.The ideal candidate will h...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Accounting Technology Consultant

    Accounting Technology Consultant

    FloQast • San Jose, CA, US
    [job_card.full_time]
    The Accounting Technology Consultant will be joining a growing Customer Success team to ensure that our newly acquired clients are successfully onboarded onto our SaaS Accounting solution.We are lo...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    IT Reporting Analyst SQL SSRS BO

    IT Reporting Analyst SQL SSRS BO

    Resource Informatics Group Inc • San Jose, CA, US
    [job_card.full_time]
    Job Description – IT Reporting Analyst.A more detailed scope of work may be further defined with the Contractor but the preliminary scope is as follows : . The Reporting Analyst is responsible f...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Sr. Analyst, Payments Partnerships

    Sr. Analyst, Payments Partnerships

    PayPal • San Jose, CA, United States
    [job_card.full_time]
    PayPal has been revolutionizing commerce globally for more than 25 years.Creating innovative experiences that make moving money, selling, and shopping simple, personalized, and secure, PayPal empow...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Deposit Sales Relationship Manager

    Deposit Sales Relationship Manager

    MRINetwork Jobs • Monterey, CA, US
    [job_card.full_time]
    Immediate opening for Deposit Sales / Relationship Manager with a very successful regional financial institution.Focus is to generate core deposits and establish deposit management relationships.Very...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Salesforce Analytics - Reporting

    Salesforce Analytics - Reporting

    Sandisk • Milpitas, CA, US
    [job_card.full_time]
    Sandisk understands how people and businesses consume data and we relentlessly innovate to deliver solutions that enable today’s needs and tomorrow’s next big ideas.With a rich history ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Sr. Tax Analyst (27683)

    Sr. Tax Analyst (27683)

    Supermicro • San Jose, CA, United States
    [job_card.full_time]
    Supermicro is a Top Tier provider of advanced server, storage, and networking solutions for Data Center, Cloud Computing, Enterprise IT, Hadoop / Big Data, Hyperscale, HPC and IoT / Embedded customers...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Physical Therapist

    Travel Physical Therapist

    CompHealth Inc. • Monterey, CA, US
    [job_card.permanent]
    Physical Therapist for a travel job in Monterey, California.Job Description & Requirements.When it comes to finding the perfect locums assignment, sometimes it is all about who you know.CompHea...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Consultant, Advanced Experience Analytics

    Consultant, Advanced Experience Analytics

    VirtualVocations • Santa Clara, California, United States
    [job_card.full_time]
    A company is looking for a Consultant, Advanced Experience Analytics.Key Responsibilities : Leads complex experience analytics projects to improve customer experience and loyalty Develops and imp...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Oracle Financial Reporting & Analytics Consultant

    Oracle Financial Reporting & Analytics Consultant

    Trident Consulting • San Jose, CA, United States
    [job_card.full_time]
    Oracle Financial Reporting & Analytics Consultant.Remote (Occasional Travel Covered by Client) or Bay Area.The Oracle Financial Reporting & Analytics Consultant will lead the design and development...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Solutions Consultant

    Solutions Consultant

    Workato • Palo Alto, CA, US
    [job_card.full_time]
    Workato transforms technology complexity into business opportunity.As the leader in enterprise orchestration, Workato helps businesses globally streamline operations by connecting data, processes, ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Channel and Alliances Director - SIs, North America

    Channel and Alliances Director - SIs, North America

    Cloudinary • San Jose, CA, US
    [job_card.full_time]
    Cloudinary is the Image and Video API platform trusted by millions of developers and over 10,000 companies worldwide.Our powerful tools fuel websites to be faster, richer in user engagement, and br...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Treasury Analyst

    Treasury Analyst

    Cypress HCM • San Jose, CA, US
    [job_card.full_time]
    Location : San Jose, CA (Hybrid).Duration : 1 9 / 15 / 2025 to 3 / 13 / 2026.In this role, you will take ownership of core global cash management processes, ensuring accurate liquidity execution, safeguardin...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Investment Analyst – AI Trainer ($50-$60 / hour)

    Remote Investment Analyst – AI Trainer ($50-$60 / hour)

    Data Annotation • Santa Cruz, California
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Radiation Therapist

    Travel Radiation Therapist

    LanceSoft • Santa Cruz, CA, US
    [job_card.permanent]
    LanceSoft is seeking a travel Radiation Therapist for a travel job in Santa Cruz, California.Job Description & Requirements. Certifications : ARRT(T), BLS, State License.Required experience : Elek...[show_more]
    [last_updated.last_updated_30] • [promoted]