Business Analytics Senior Manager Integrity - Risk & Affordability; Remote

About the Role

The Payment Integrity Analytics Team focuses on measurement and analytics for national Payment Integrity programs. As a Business Analytics Senior Manager, you’ll lead a team of analysts supporting Payment Integrity initiatives, blending healthcare data analytics, AI, and financial insight, with a strong emphasis on influencing decisions at the executive level.

This role comprehensively examines the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, and healthcare industry operations to streamline medical costs for health plan members.

It partners closely with stakeholders across finance, operations, clinical, product, and network teams to evaluate trends, support proposals, and ensure accurate financial measurement for new programs and initiatives.

• Lead strategic analytics by identifying medical cost drivers, trends, risks, and affordability opportunities.
• Develop and execute analysis and AI to support Payment Integrity strategies at the enterprise level, ensuring alignment across business units and enterprise financial goals.
• Translate analytical findings into clear, executive‑ready insights that influence decisions across technical, operational, and senior leadership audiences.
• Own financial business cases for new affordability initiatives, including forecasts, variance analysis, and recommendations to improve performance.
• Oversee analytics for initiatives, policy changes, and ongoing performance monitoring.
• Improve reporting and visualization by assessing current capabilities and advancing self‑service analytics solutions, utilizing AI tools for quality, accuracy, and reporting.
• Modernize analytics through scalable methods, automation, and thoughtful use of AI‑enabled tools where they add value.
• Monitor and conduct research of related affordability, AI, and business trends, advising senior management on Payment Integrity strategy.
• Manage and develop a team of analysts, setting clear priorities, ensuring high‑quality output, and supporting continuous skill development.
• Balance multiple initiatives by prioritizing and delegating work effectively in a fast‑paced, dynamic environment.
• Ensure data quality and accuracy by implementing appropriate checks, controls, and processes.
• Act as a trusted thought partner to senior leaders by proactively identifying insights, risks, and emerging trends that inform near‑ and long‑term affordability strategy.

• Proven ability to translate complex analyses into actionable business insights.
• Clear, confident communication skills with experience presenting to senior and executive audiences.
• Demonstrated success managing multiple priorities and leading teams in a matrixed environment.
• A creative, critical thinker with strong attention to analytical accuracy.
• Comfortable working independently while collaborating closely with cross‑functional partners.
• Self‑starter with a strong orientation toward continuous improvement, ownership, and impact.

• Bachelor’s degree or equivalent in a quantitative field such as Economics, Finance, Data Science or Analytics, Business, Applied Mathematics, Public Health, Actuarial Science or similar.
• Master’s degree preferred.
• 7+ years of progressive experience in predictive analytics, financial modeling, healthcare economics, or related fields, including experience leading or mentoring analysts.
• Strong analytical and technical skills, with hands‑on experience using tools such as SQL, Excel, SAS, Databricks, Tableau, or similar platforms.
• Experience with and knowledge of medical claim coding and provider reimbursement.
• If you will be working at home occasionally or permanently, the internet connection must be a cable or fiber broadband service with speeds of at least 10
  
  Mbps download/5
  
  Mbps upload.

• Annual salary range of $130,900 – $218,100 USD, depending on experience.
• Eligible to participate in an annual bonus plan.
• Medical, vision, dental, and well‑being and behavioral health programs.
• 401(k) plan.
• Company paid life insurance.
• Tuition reimbursement.
• Minimum of 18 days of paid time off per year and paid holidays.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.