Job Description
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.
Vendor and program oversight, leveraging medical data to identify trends and opportunities to support the oversight. Determine requirements, create standards and/or define metrics to ensure complete and accurate reporting. In partnership with vendor, provide insight and recommendations using quantitative analysis coupled with explanatory to drive focused decision making. Performs other duties as assigned.
Key Accountabilities - Data Validation & Quality Assurance
- Analyze and validate Medicaid encounter data submissions for accuracy, completeness, and compliance with CMS/DHS and state requirements
- Identify and resolve data anomalies, errors, and inconsistencies
- Reporting & Analytics
- Develop, generate, and analyze business performance reports (e.g., claims, provider, utilization data)
- Identify trends and provide actionable insights to support decision-making and regulatory compliance
- Process Improvement & Compliance
- Assist in developing and refining data quality management processes and procedures
- Support CMS/DHS audits and other regulatory reporting requirements
- Collaboration & Stakeholder Engagement
- Work with internal teams (IT, compliance, operations) and external partners (vendors, health plans) to gather requirements, resolve issues, and ensure data integrity
- System & Process Oversight
- Oversee encounter data submission processes, including reconciliation, validation, and correction of errors
- Monitor compliance with contractual and regulatory standards
Required Qualifications - Bachelor's degree or equivalent experience in related field
- 5 years of work experience beyond degree
Preferred Qualifications - 3–5 years of experience in healthcare data analysis, preferably with Medicaid or managed care encounter data
- Technical Skills:
- Strong SQL skills (highly preferred)
- Experience with large data sets, data mining, and reporting tools (e.g., SAS, Excel)
- Knowledge:
- Familiarity with Medicaid regulations, CMS/DHS requirements, and encounter data standards
- Understanding of claims processing, risk adjustment, and healthcare quality measures
- Analytical & Communication Skills:
- Strong analytical, organizational, and problem-solving skills
- Ability to communicate findings and recommendations clearly to technical and non-technical stakeholders
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN or Madison, WI.
The full salary grade for this position is $68,800 - $118,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $68,800 - $103,215. 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.
The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Job Tags
Work experience placement, Work at office, 3 days per week,