Research Analyst - Medical Management, Remote

Research Analyst - Remote

Under the direction of the Head of Providence Health Plan (PHP) Payment Integrity (PI), the Research and Development (R&D) Analyst is responsible for identifying, developing, and implementing solutions to improve the accuracy and integrity of claims payments across the Plan. This role focuses on preventing and reducing unnecessary spending by scoping PI initiatives, analyzing claims data, developing a thorough implementation assessment plan, and collaborating with internal and external stakeholders to optimize the payment processes. This is accomplished by leveraging a deep understanding of Providence Health Plan infrastructure, claims edit and processing platforms, Plan policy, regulatory/compliance, benefit, and contracting functions to synthesize meaningful and actionable PI initiative recommendations.

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

This role offers 100% remote work for candidates residing in:

• Oregon
• Washington
• California

Required Qualifications:

• Bachelor's Degree, or 3 years equivalent experience. 
• 3 years experience with performance improvement/organizational change tools.
• 3 years experience working with large data sets and analytics teams.
• 3 years claims processing experience within the health insurance industry.
• Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices.
• Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design.

Salary Range by Location:

California: Humboldt: Min: $33.05, Max: $51.30

California: All Northern California - Except Humboldt: Min: $37.08, Max: $57.56

California: All Southern California - Except Bakersfield: Min: $33.05, Max: $51.30

California: Bakersfield: Min: $31.71, Max: $49.22

Oregon: Non-Portland Service Area: Min: $29.56, Max: $45.88 

Oregon: Portland Service Area: Min: $31.71, Max: $49.22

Washington: Western : Min: $33.05, Max: $51.30

Washington: Southwest - Olympia, Centralia & Below: Min: $31.71, Max: $49.22 

Washington: Eastern: Min: $28.21, Max: $43.80

Washington: South Eastern: Min: $29.56, Max: $45.88 

Why Join Providence Health Plan? 

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.