Provider Reimbursement Analyst

Provider Reimbursement Analyst – Job Overview

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through a range of health, life, disability, dental, vision and indemnity plans. Medical Mutual offers fully insured and self‑funded group coverage, including stop loss, Medicare Advantage, Medicare Supplement and individual plans.

The position is a hybrid role – 3 days per week on site at the Brooklyn, Ohio office. Applicants must reside within a 50‑mile radius of the office.

• Analyze utilization, cost, contract valuation, competitive benchmarks, and financial impact data as directed; translate findings into clear, actionable insights for decision‑making.
• Update and validate provider rate loading to ensure accuracy and compliance with contract terms.
• Provide tactical support to senior analysts by extracting and preparing data for robust quantitative analysis.
• Extract and manipulate data from multiple sources to develop analytic datasets and present findings in a clear, concise format.
• Support rate strategy development and analyze emerging payment models to inform contracting decisions.
• Assist in forecasting contract rates and utilization trends; build basic financial models and “what‑if” scenarios using claims data.
• Support fee schedule development and quality checks; maintain clear documentation of updates and processes.
• Perform other duties as assigned.

• Develop complex deal models in collaboration with Network Management to support contracting.
• Analyze performance using utilization, cost, contract valuation, competitive benchmarks, and financial impact metrics.
• Support rate strategy development by identifying opportunities to optimize contracted rates and protect favorable structures through financial analysis.
• Update and validate provider rate loading to ensure accuracy and compliance with contract terms.
• Analyze emerging payment models and pricing strategies; apply knowledge of commercial and Medicare reimbursement policies to inform contracting decisions.
• Provide tactical support to senior analysts by extracting, cleaning, and preparing data for rigorous quantitative analysis.
• Forecast contract rates and utilization trends; build financial models and “what‑if” scenarios using claims and healthcare data.
• Assist in building and validating rate methodologies; ensure documentation is clear, repeatable, and aligned with update timelines.
• Interpret complex contract language to assess financial implications of proposed changes.
• Perform other duties as assigned.

• Collaborate with Network Management to shape rate strategies and contract methodologies that optimize financial outcomes.
• Build and refine complex deal models; apply advanced analytical techniques and business acumen to evaluate deal projections, benchmark performance, and assess financial impacts using utilization data, cost trends, contract valuation, and competitive analysis.
• Ensure accuracy and consistency in provider rate loading through regular updates and quality assurance reviews.
• Mentor and guide junior analysts, providing training, support, and quality oversight.
• Partner with Actuaries and Underwriting to assess regional financial impacts of contracted rates and support short‑ and long‑term forecasting.
• Develop, build, and quality‑check Institutional Reimbursement Methodologies, ensuring documentation is clear and repeatable.
• Forecast contract rates, utilization trends, and create financial models using claims and other healthcare data; develop “what‑if” scenarios.
• Interpret complex contract language to assess financial implications of proposed changes and support negotiation strategies.
• Investigate claim disputes to validate pricing accuracy; conduct root‑cause analysis on inquiry data; recommend system enhancements, targeted training, and process improvements.
• Perform other duties as assigned.

• Bachelor’s degree in business, healthcare administration, finance, accounting, or…