Director of Provider Analytics

Well Sense Health Plan is a nonprofit health insurance company serving more than 680,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded more than 25 years ago as Boston Medical Center Health Net Plan, we provide plans and services that work for our members, no matter their circumstances.

It’s an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Director of Provider Analytics reports to the Chief Actuary and leads analytics supporting provider contracting, provider performance, network strategy, and network adequacy. This role is responsible for translating provider, claims, membership, and network data into actionable insights that support contracting decisions, network development, regulatory compliance, and broader business strategy.

The Director also oversees network adequacy analysis, monitoring, and regulatory reporting using Quest software, ensuring provider networks meet applicable access and adequacy requirements and proactively identifying potential network gaps.

Lead analytics supporting provider contracting, reimbursement strategy, and provider negotiations.

Develop financial models to evaluate reimbursement proposals, contract terms, and alternative negotiation scenarios.

Analyze provider utilization, reimbursement, referral patterns, and performance to identify key trends and opportunities.

Assess provider reimbursement relative to internal and external benchmarks.

Quantify the financial impact of proposed contract and network changes across products and markets.

Provide Network Strategy leadership with clear, actionable insights to support contracting strategy and decision-making.

Partner with Actuarial to evaluate the financial implications of significant provider contracting and network changes.

Lead network adequacy analysis, monitoring, and reporting using Quest software.

Oversee preparation, validation, and submission of required network adequacy reports.

Assess provider accessibility and geographic coverage across specialties, facility types, products, and service areas.

Identify network gaps and partner with Provider Network teams to develop appropriate remediation strategies.

Proactively evaluate the impact of provider terminations, network changes, membership growth, geographic shifts, and new product or service area expansion on network adequacy.

Lead or oversee CHIA data submission processes, including data preparation, validation, reconciliation, and timely submission in accordance with applicable requirements.

Establish appropriate data quality controls and validation processes to ensure the accuracy, completeness, and consistency of CHIA submissions.

Partner with internal stakeholders to investigate and resolve data quality issues, submission errors, and reporting discrepancies.

Maintain strong analytical controls, documentation, and quality assurance processes to support accurate and auditable regulatory reporting.

Serve as the organization's analytical subject matter expert for network adequacy, CHIA reporting, and related provider data.

Provide analytics supporting network development, provider recruitment, geographic expansion, and network optimization.

Evaluate provider supply, geographic coverage, member access, referral patterns, and network concentration.

Assess the potential membership, financial, access, and competitive implications of network changes.

Identify opportunities to strengthen the…