Business Analyst

About the role

The Business Analyst, Market Provider Relations, supports the Texas Market Provider Relations leadership team by providing dedicated analytical, reporting, operational, and project support.

Responsibilities

• Support the Market Provider Relations leader and leadership team with day-to-day operational tracking, issue documentation, and follow-up on provider-facing priorities.
• Maintain market-level trackers for provider issues, escalations, claims concerns, authorization concerns, configuration issues, roster discrepancies, and health plan follow-up items.
• Ensure Provider Relations leadership has accurate, timely, and organized information to support provider meetings, Joint Operating Committees, internal leadership meetings, and executive updates.
• Track action items assigned to Provider Relations leaders and team members, including owners, due dates, status updates, barriers, and next steps.
• Develop and maintain recurring reports and dashboards to support Provider Relations leadership decision-making.
• Analyze provider-level and practice-level data related to membership, claims, authorizations, quality gaps, risk adjustment activity, utilization, ACO participation, and financial performance.
• Create executive-level summaries and market updates that translate complex data into clear, actionable insights.
• Support analysis of provider performance trends, including quality, cost, utilization, readmissions, membership movement, and value-based care performance.
• Support tracking and analysis of health plan delegation issues, including provider loading, roster accuracy, effective dates, claims routing, authorization routing, payer ID issues, and provider directory concerns.
• Maintain documentation of open health plan issues and support follow-up with internal teams, health plans, and Provider Relations leadership.
• Track provider concerns related to WellCare, WellPoint, SCAN, Humana, Aetna, Cigna, Ambetter, and other delegated or contracted health plan arrangements.
• Support ACO recruitment tracking, provider participation documentation, TIN/NPI validation, deadline management, and submission readiness.
• Aid in provider-level analysis related to ACO eligibility, performance, membership, quality gaps, utilization trends, and financial opportunity.
• Maintain ACO recruitment and participation trackers to ensure leadership has visibility into progress, barriers, and outstanding provider follow-up.
• Prepare materials for provider meetings, internal leadership meetings, JOCs, board meetings, and executive discussions.
• Provide project support for market initiatives, including IPA transitions, new health plan go-lives, provider engagement campaigns, contracting transitions, delegation readiness, and operational improvement efforts.
• Partner with Provider Relations, Contracting, Data, UM, Claims, Quality, Risk Adjustment, Finance, Credentialing, and Health Plan Operations teams to gather updates and support issue resolution.
• Identify gaps in process, documentation, reporting, or follow-up and recommend improvements to support stronger market execution.

Qualifications

• Bachelor's degree in Business, Healthcare Administration, Finance, Data Analytics, Public Health, or a related field preferred.
• Minimum of 3 years of experience in healthcare operations, provider relations, managed care, business analysis, data reporting, or project coordination.
• Strong proficiency in Microsoft Excel, including pivot tables, VLOOKUP/XLOOKUP, formulas, filtering, and data validation.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities, deadlines, and stakeholders in a fast-paced environment.
• Ability to work independently while collaborating across cross-functional teams.

Skills

• Strong analytical skills with the ability to review, organize, and interpret large amounts of provider, claims, roster, quality, and operational data.
• Ability to translate complex data into clear summaries, dashboards, and actionable recommendations.
• Strong attention to detail and ability to identify discrepancies across multiple systems and reports.
• Excellent organizational and follow-up skills with the ability to manage multiple priorities, deadlines, and stakeholders.
• Strong written and verbal communication skills.
• Ability to work independently while collaborating across cross-functional teams.
• Understanding of provider relations, managed care, IPAs, ACOs, delegation, claims, authorizations, quality, risk adjustment, and value-based care preferred.
• Ability to maintain confidentiality and handle sensitive provider, patient, and business information appropriately.